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What Are Eating Disorders?
ANOREXIA NERVOSA (affecting 1% of the female population) has been recognized for over a century. It is a disruption in normal eating habits characterized by an all-consuming fear of becoming "fat". There is an intense preoccupation with food and body size, and a tendency for compulsive exercise. It typically starts in teenage women when normal dieting develops into excessive weight losses - perhaps to more than 25% of original body weight. Severe cases can lead to death. Normal body functions become affected (menstruation ceases), and the physical symptoms of malnutrition appear (lowered heart rate and blood pressure, decreased metabolism, and sensations of coldness).
People with anorexia nervosa usually function far below their potential, and are obsessed with food and dieting. Occasional binge eating and purging can occur as a method of achieving weight loss (usually with a far more extreme result that results in bulimia). Sufferers are frequently depressed, and usually deny that they have a problem. Even severe weight loss will not dimish the perception of being too "fat".
BULIMIA, recognized by professionals since the early 1970s, is estimated to affect 5-20 women in one hundred. It is a cycle of uncontrolled binge eating followed by purging through vomiting, the use of laxatives, or excessive exercise. People with bulimia are often of normal, or even slightly over normal, weight. Bulimia can range from a mild infrequent response to stress, to a pattern consuming nearly all of a person's time and money. A most severe case could involve binge eating and purging several times daily.
Bulimia usually begins benignly, where purging appears to be a convenient way of eating without gaining weight. However, individuals can quickly become aware that this pattern is destructive and out of control. They may feel guilty and depressed after a binge. Nevertheless, the cycle increasingly dominates their thoughts and behavior. It commonly impairs relationships and activities, and leads to depression and low self-esteem. People with bulimia often feel a sense of shame and helplessness that makes it difficult to seek help.
The physical effects of bulimia can be serious. Frequent vomiting can cause permanent damage to tooth enamel, as well as to the tissues of the throat and esophagus. Seizures, kidney, and cardiac problems are a significant danger.
Causes of Eating Disorders
Experts have not identified exact causes of eating disorders. Nor can they explain why both disorders appear to be on the increase. However, it is known that both women and men (though less frequently seen in men) are affected, and that biological, physical, and social factors play a part in the onset of an eating disorder.
Least is known about the biological factors, although the presence of inherited mood swings and depression are indicated. Other evidence connects major depression and alcoholism in blood relatives of persons with bulimia or anorexia nervosa. Antidepressant medication under the supervision of a physician has been helpful to some individuals in controlling the binge-purge cycle.
The psychological development of people with eating disorders has been studied in greater detail. It is speculated that anorexia may function as an attempt to gain control of life circumstances. Even as an avoidance of the complexities of physical and emotional maturation. The UCLA Eating Disorder Program has described a profile of individuals with anorexia as "model children", intelligent, perfectionistic, with high personal standards. High expectations within families may contribute to anorexia nervosa. Sufferers want to please, but have low self-esteem and may be depressed.
Although persons with bulimia also have low self-esteem, they are often socially active with a higher level of energy. They usually date and may use drugs and alcohol. The binge-purge cycle is thought to function as a relief from anxiety or emotional stress.
Social factors also seem to contribute to eating disorders. Females have traditionally felt more pressure than males to conform to physical stereotypes (perhaps explaining the significant imbalance in females with eating disorders versus males). Our culture's excessive emphasis on the slim female figure puts pressure on the already struggling maturing girl. Increasing numbers of teenage girls attempt to make their bodies conform by resorting to extreme diets or purging. Some will become trapped in the destructive cycle of an eating disorder.
An important first step is for the person to acknowledge that an eating disorder is a problem. Attempts at self help are rarely successful, and the longer the disorder remains unchecked the harder it may be to overcome. Medical and psychological help should be sought from experienced professionals. A complete physical examination and lab test may be necessary.
Psychotherapy (individually or in a group) is recommeded, providing immediate relief from the feeling of living a "secret" life, and increasing self-esteem. It may be supplemented by nutrition education.
These medical, psychological, and educational treatments can be effective on an outpatient basis. In extreme cases, e.g. where body weight is dangerously low, or where bulimia is completely out of control, temporary hospitalization may be required.
How To Help Someone Who Has An Eating Disorder
- Don't nag. Don't spy. The most you will do is increase the person's discomfort and force them to be more secretive about their eating habits.
- Don't agree to help control binging by hiding food. The person with bulimia may request this "help" but end up resenting it (and finding another way to binge).
- Do remember this is first a person, and only secondarily one who has trouble with food.
- Do listen. One of the best ways to help is to reach out as a friend, rather than to focus on the disorder.
- Do be supportive and encourage the person to get professional help. Don't let yourself be convinced the problem isn't there. The problem exists and there is hope.
Some excellent books are:
Hall, Lindsey. Full Lives: women who have freed themselves from food and weight obsession.
Hall, Lindsey & Cohn, Leigh. Bulimia: a guide to recovery.
Zerbe, Katheryn, J. The Body Betrayed: women, eating disorders, and treatment.
Kano, Susan. Making Peace With Food: freeing yourself from the diet-weight obsession.
Rodin, Judith. Body Traps.