Eating Disorders Center

Eating Disorders Overview

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.

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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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