Eating Disorders (Anorexia Nervosa, Bulimia)
Two of the most serious eating disorders are anorexia nervosa, a complex disease characterized by a distorted body image and self-starvation, and bulimia, which involves eating huge quantities of food followed by purging, usually through self-induced vomiting and/or laxative abuse. More than 90 percent of those with either of these conditions are adolescent girls or young women; boys are affected only occasionally. Some persons have features of both disorders.
Anorexia nervosa typically begins during early adolescence when a young girl becomes convinced that her maturing body is fat. Anorexics tend to be high achievers and are often described as obedient, ideal daughters. Some psychiatrists theorize that their eating behavior represents one aspect of life they feel they can control.
A person with anorexia chronically under-eats, becoming thinner and thinner and, in extreme cases, literally starving to death, while remaining firmly convinced that she is overweight. Many anorexics expend a great deal of time and energy in preparing food, which they serve to others while eating only tiny amounts themselves. In addition, some of them have ritualistic eating habits, such as cutting food up into tiny pieces or arranging it very precisely on the plate.
The bulimic goes on periodic food binges, gorging on a large quantity of food in a short period of time. These binges are followed by purges, in which the individual forces vomiting and/or uses drugs to stimulate vomiting and bowel movements. Some bulimics also abuse diuretics, drugs that increase excretion of body fluids; others abuse amphetamines to prevent weight gain. Bulimics and anorexics are secretive about their eating habits and typically deny that they have a problem. They tend to be obsessive about exercising. Many have low self-esteem, and some bulimics also exhibit other addictive behavior, such as alcohol abuse and compulsive shoplifting.
What causes these eating disorders is unknown, but some experts blame problematic family relationships. However, research suggests that eating disorders stem in part from brain chemical and hormonal imbalances.
Anorexia and bulimia are potentially fatal diseases. Anorexics can literally starve themselves to death, while bulimics have a high suicide rate. Metabolic and other changes brought about by their erratic eating behavior increases their risk of heart disease.
Diagnostic Studies and Procedures
Even if an eating disorder is suspected, the first step is a complete physical examination to rule out other illnesses, such as cancer or a chronic infection, particularly if extreme weight loss has occurred. While conducting the examination, the doctor will look for signs of anorexia and bulimia.
Indicators of anorexia include dry skin, thinning and brittle hair, low blood pressure, and a slow heart rate -- all signs that the body is responding to starvation by shutting off or slowing down functions that are not vital to sustaining life. Some anorexics complain of constipation and intolerance to cold, and may even develop a soft body hair called lanugo as a response to the lower body temperature that occurs when body fat is lost. Another major symptom of anorexia is the absence of menstruation, due to the loss of body fat and the resulting hormonal changes. Mild anemia, lightheadedness, and sleep problems also suggest anorexia.
In diagnosing bulimia, the physical examination and medical history are also highly important. The doctor will
look for damage to the teeth and gums caused by repeated exposure to the stomach acids in vomit. The esophagus may be inflamed due to vomiting, and glands near the cheeks might also be swollen. One or more fingers could be scarred as a result of pushing them down the throat to induce vomiting, and menstrual periods are likely to be irregular. The doctor will ask about dieting and exercise habits, as bulimics frequently diet and exercise incessantly without losing weight and generally regain weight if they do lose it.
Medical Treatments
Treatment of an eating disorder requires both psychological and medical care. Some form of psychotherapy is necessary, as well as medications if the person is severely depressed.
Anorexics often require hospitalization to treat malnutrition and other medical complications of starvation. Even then, calorie intake must be monitored closely to be sure the patient is eating, rather than hiding or disposing of food. (Anorexics have many strategies for misleading others into thinking they have eaten when they have not.)
Intravenous, or tube, feeding, bed rest, and intensive nursing care will probably be needed in order to restore the lost weight. At the same time, behavioral therapy is almost always called for to help change compulsive eating habits and obsessions concerning staying thin.
In many cases, psychological counseling is also recommended for the parents and other family members. Often, the mother also has a history of an eating disorder. She may be overweight or put undue emphasis on being thin. Some psychiatrists theorize that an anorexic daughter may be fulfilling her parents' unconscious desire that she remain a child.
Hospitalization for bulimics is rare, except for some patients who are very depressed. Group therapy works well for many bulimics, who tend to be ashamed of their binging and so feel relieved to find they are not alone in this behavior. Once they are able to discuss the problem in a therapeutic setting, treatment is more likely to work for them.
An antidepressant drug may be prescribed in conjunction with dietary and behavioral therapy. Such drugs help control mood by increasing levels of serotonin (a brain chemical with a calming effect) in the circulation.
Alternative Therapies
Biofeedback and Visualization. These two techniques can be combined to reduce stress and help the person create new thought patterns to control compulsive eating habits. During biofeedback training, she becomes aware of the body's responses to compulsive behavior, which enables her to control them. Visualization involves "seeing" a desired response. The bulimic, for example, might learn to see herself eating a normal amount of food and then leaving the table feeling satisfied rather than guilty for overeating.
Hypnosis. Combined with other psychotherapeutic approaches, hypnosis and self-hypnosis can help the bulimic to control the impulse to binge and purge, and the anorexic to overcome the perception of being too fat.
Meditation. Yoga and other forms of meditation can help a person with an eating disorder to control stress, which is essential if treatment is to succeed.
Nutrition Therapy. This is the key to overcoming any eating disorder. A nutrition counselor can provide an understanding of the body's needs for well balanced meals and point out the health hazards of overly restrictive diets. The binge eater and the anorexic both need to learn how to plan menus and set reasonable goals for eating and weight control. The anorexic must also learn to accept more normal concepts of what constitutes ideal weight, overweight, and underweight, and to understand what the consequences of extreme thinness can be. Frequent sessions with a nutritionist may be necessary over a period of time, so that eating habits and weight can be monitored.
Self-Treatment
Because people with eating disorders typically deny their problem, ignoring symptoms and constructing elaborate strategies for deceiving others about their eating habits, self-treatment is usually not effective unless supported by some form of therapy. In general, people with eating disorders are unlikely to seek treatment on their own. Yet the earlier treatment begins, the more likely it is to be successful.
During psychotherapy, anorexics and bulimics gradually team to stop denying that they have a problem and to set goals for maintaining normal eating habits. Family members may need counseling to understand how they can be helpful and how to avoid being misled or making the problem worse.
Other Causes of Weight Loss
Many serious illnesses can cause severe weight loss and an emaciated appearance; these include cancer, heart disease, thyroid disorders, and AIDS.