A Body To Die For: The ABC's Of Eating Disorders

I had gone to a lot of trouble to land myself in the hospital. At 15, I had embarked on a diet and had shed 50 pounds in six months. My body had started out slightly padded, clad in baggy painter's pants to conceal my thighs. As I shrank, I wore tighter pants to flaunt my success, until those too began to hang on my diminishing frame.

- from Evelyn Strauss's, "Facing the Plate" (Salon 9/13/00), a personal account of the author's experience with an eating disorder.

This is a horrifying but typical picture of a young woman suffering from an eating disorder — something that, according to the National Institute of Mental Health, affects more than five million Americans today.   Aside from cases where depression or other mental illness leads to suicide, it is hard to think of a psychological problem that poses a greater threat to a person's physical health. Those afflicted with eating disorders try to lose weight by dieting, purging or other means until they make themselves sick. Though some get treatment and recover, others literally starve themselves to death. 

As Ms. Strauss's story illustrates, a particularly troublesome aspect of this illness is that while its victims may appear not to understand that they are making themselves sick, most of the time they know exactly what they are doing to their bodies. In cases like these, friends and family members can beg, plead and try all they want to convince victims that they are too thin or that they are ruining their health but they continue to do it anyway. 

What can you do if you or someone you care about is suffering from an eating disorder? The good news is that there are treatments. The first step, however, is to become informed about what eating disorders are, the different kinds and how they affect the body. 

There are two main types of eating disorders. Their technical names are anorexia nervosa and bulimia nervosa. The table below shows the main ways in which they differ.

Eating disorders are a uniquely dangerous form of mental illness. 

Table 1.

Eating Disorders

(Based on the American Psychiatric Association's Diagnostic and Statistic Manual, IV)

Anorexia Nervosa

1. Refusal to maintain body weight at or above a minimally normal weight for age
2. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
3. In postmenarcheal females, amenorrhea, i.e., for at least three consecutive menstrual cycles.

Restricting Type:

person not regularly engaged in binge-eating or purging behaviors

Binge-Eating/Purging Type:

In addition to symptoms of anorexia nervosa, the person regularly engages in binge-eating or purging behaviors.

Bulimia Nervosa

1. Recurrent episodes of binge eating characterized by 1) eating in a discrete amount of time a large amount of food and 2) a sense of lack of control over eating during the episode
2. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, and other medications; fasting or excessive exercise
3. The binge-eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months
4. Self-evaluation is unduly influenced by body shape and weight
5. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Purging Type:

During episodes of bulimia nervosa, the person regularly engages in self-induced vomiting, misuse of laxatives, diuretics, or enemas.

Nonpurging Type:

During the episodes of bulimia nervosa, the person has used other inappropriate compensatory behavior such as fasting or excessive exercise but has not regularly engaged in the purgative methods listed above. 

What Are the Warning Signs?

Some of the common early warning signs of bulimia are extreme weight fluctuations, preoccupation with diet and really bad breath. Typically, a victim's family or doctor might notice that the victim's weight is going up and down over a period of months or years. The victim may begin to abuse diuretic drugs or laxatives, begin to exercise obsessively or make themselves vomit after meals. Repeated self-induced vomiting leads in the short term to bad breath and in the long run to dental and other physical problems. When confronted, however, the typical bulimic will deny everything.

When asked to explain their behavior, both anorexia and bulimia victims will insist, no matter how objectively thin they may be, that they "feel fat."  These feelings can be so extreme and unreasonable that doctors often conclude that victims are mentally ill and have lost contact with reality.3 Deep down, however, this is not the case. In fact, those with eating disorders understand how they really look and what they are doing to themselves. The problem is not that they are irrational or out of contact with reality, but rather that they cannot control their behavior. 

Another warning sign of an eating disorder is excessive concern with a particular part of the body. Victims may turn to plastic surgery or liposuction to fix a supposed physical flaw or just to "stay thin." 

Certain psychiatric problems often accompany eating disorders. These include depression, anxiety disorders (especially obsessive-compulsive disorder), borderline personality disorder and substance abuse. 

Who Are the Victims?

Traditionally, most victims of eating disorders have been thought to be White, economically well-off girls or young women. This remains largely true, although the picture does seems to be changing. Recent studies have shown that growing numbers of African-Americans and other minorities are becoming afflicted with eating disorders, especially bulimia.

Boys and men are also at increasing risk for eating disorder. Although studies show that nine out of ten victims are female, males who participate in certain sports (e.g., wrestling, gymnastics, running), are homosexual, or who suffer from addiction or personal disorders are at greater risk of developing an eating disorder. Anorexic males can be just as preoccupied with body image as females, but tend to want to have a slender waist and muscular, athletic shoulders and chest. This is sometimes called "reverse anorexia".

Eating disorders are appearing among all socioeconomic groups. They are crossing age barriers, showing up in younger and younger children. More and more preschool and grade schoolers are developing eating problems, showing preoccupation with weight and size, and going on diets.

What Is the Cause?

No one has found an exact cause of eating disorders. There are, however, circumstances and influences that make some people more vulnerable. Among preschool children, studies have found a strong association between eating problems and extreme parental attitudes about food and weight, particularly for children of a mother with an eating disorder.    Ironically, being overweight is also a contributing factor. And childhood obesity is definitely on the rise. 

Today, as many as 50% of grade school children are overweight. This has caused an increase in diseases in children that were once seen almost exclusively in adults, such as Type 2 diabetes. Studies indicate that youngsters who are teased or feel ashamed about their weight are much more likely to develop an eating disorder when they are older. (Parents should be aware that in some cases, children who show symptoms of anorexia may in fact have a pediatric autoimmune neuropsychiatric disorder (known as PANDAS) that is associated with streptococcus infection. This can be cured with antibiotics. 

Some people also seem to carry a gene that makes them more likely to develop anorexia nervosa or bulimia nervosa. 

Finally, a startlingly high percentage — in the range of 30% to 60% — of those with eating disorders are victims of past childhood physical or sexual abuse, or of a more recent adult trauma such as rape. This could explain why post-traumatic stress disorder is more common in those with eating disorders.

Read the rest of this article here:- http://www.thedoctorwillseeyounow.com/content/behavior/art1960.html?getPage=1