Eating disorders

INTRODUCTION

Each year millions of people are affected by serious and sometimes life-threatening eating disorders. Most of them –90 percent - are adolescent and young adult women. One reason why women of this age group are particularly liable to eating disorders is their tendency to go on strict diets to achieve an „ideal“ figure.1)

These eating disorders also occur in men and older women, but much less frequently.

The consquences of eating disorders can be severe. For example, one in ten cases of anorexia nervosa leads to death from starvation, cardiac arrest, other medical complications, or suicide.2)

Scientists have found out that people with eating disorders who get an early treatment have better chances of full recovery than those who wait years until they seek help.3)

DEFINITIONS

The most common element surrounding ALL eating disorders is the presence of a low self esteem.4)

ANOREXIA NERVOSA

Anorexia nervosa is characterized by a meaningful weight loss resulting from excessive dieting. Most women, especially adolescent girls and an increasing number of men are motivated by the strong desire to be thin.

Anorexia may not be noticed in the early stages, because it often starts as an innocent diet. Anorexics often become hyperactive because they exercise a lot to burn calories to lose weight.

In the attempt to become thinner the anorexic will avoid food and taking in calories, which can result in death.

COURSE:

Sometimes a person with anorexia begins to diet in order to lose only a few pounds, but then they can´t stop. In the later and more dangerous stages, the disease may not be noticed by family members and friends because the anorexic person often wears big and baggy clothes. Most persons who are suffering from anorexia nervosa strongly deny the disorder. Even though they look emaciated they are convinced to be overweight.It´s not uncommon for people who develop the disorder to starve themselves until they weigh just 60 or 70 pounds.5)

BEHAVIOUR:

Anorexics usually strive for perfection. They set very high standards for themselves. A person with anorexia nervosa often thinks that the only control which they have in their lives is in the area of food and weight. Each morning the number of the scale will decide if they have succeeded or failed. They feel powerful and in control when they can make themselves lose weight. Sometimes losing weight and burning calories is their way to block out feelings and emotions. For them, it is easier to diet than to deal with their problems directly.

An anorexic may have ritualistic eating patterns such as cutting the food into tiny pieces ad weighing every piece of food before eating it. These behaviours can also be found in people who are on a normal, healthy diet, but anorexics exaggerate extremely these behaviours.6)

They deny that anything is wrong so strongly that the idea of undergoing therapy is seen only as a way to force them to eat. Often they must be hospitalized to prevent starvation. But only if they become aware of the fact that they have a problem, they can be treated effectively through a combination of psychological, nutritional and medical care.

Anorexia was first defined as a medical problem in 1873. But descriptions of self- starvation have already been found in medieval writings.7)

BULIMIA NERVOSA

Bulimia nervosa is an emotional disorder characterized by episodes of binge eating followed by some form of purging. Binges are the rapid consumption of high-caloric foods over a certain period of time.A binge can be different for all individuals. For one person a binge may range from 1,000 to 10,000 calories. For others, one piece of cake may be considered as a binge.8) Bulimics counteract a binge by self-induced vomiting or laxative abuse. Other forms of purging can also be excessive exercise, fasting cures, use of diuretics, diet pills and enemas.

This binge-purge cycle is normally accompanied by self-deprecating thoughts, depressed mood, and an awareness that the eating behaviour is abnormal and out of control.

Most persons with this disorder are women, but bulimia has also been diagnosed in men. Bulimia nervosa usually develops in late adolescence and early adulthood. Bulimics are often people who feel lacking in self-confidence. They tend to do whatever they can to please others, while they are hiding their own feelings and emotions.

Bulimia nervosa is a method of ”weight control“ rather than ”weight loss“. Most persons suffering from this disorder are frequent dieters but stay within a normal weight range. They binge and purge in secret and maintain their normal body weight, so they can often successfully hide their problem from others for years.

Food takes on a symbolic meaning for them, and the binge-purge cycle can show their feelings of frustration, disappointment, anger, loneliness, and boredom. With their eating behaviours they deal with their liefe stresses. Bulimia can be accompanied by other impulsive behaviours such as shoplifting or alcohol and drug abuse.

Patients who are diagnosed with Bulimia nervosa have on average about 14 episodes of binge-purging per week. People with Bulimia that doesn´t progress to

Anorexia nervosa have a normal to high-normal body weight, but it may fluctuate by more than 10 pounds because of the binge-purge cycle.9)

Experts of the NationalEatingDisorderOrganization (NEDO) claim that the problem of bulimia nervosa ist underestimated because many people with bulimia are able to hide their purging and don´t become really underweight.

COMPULSIVE OVEREATING

Compulsive overeating is characterized by uncontrollable eating and consequent weight gain. Compulsive overeaters use food as a way to cope with stress, emotional conflicts and daily problems. The food can block out feelings and emotions. Compulsic overeaters usually feel out of control and are aware that their eating patterns are abnormal. Like bulimics, compulsive overeaters realize that they have a problem.

Compulsive overeating usually starts in early childhood when their eating patterns are formed. Most people who become compulsive eaters are people who have never learned the right way to deal with stressful situations. Compulsive overeaters often use food instead as a way of coping with their problems. Fat can also be a protective function for them, especially for people who have been victims of sexual abuse. They sometimes think that their overweight will keep others at a distance and make them less attractive. Unlike anorexia and bulimia nervosa, there is a high proportion of male overeaters.

Today, compulsive overeating is not taken seriously enough. Instead of being treated for the serious problem they have, they are instead directed to diet and health centres. Like anorexia and bulimia nervosa, compulsive overeating is a serious problem and can result in death. An effective treatment should include psychological therapy, medical and nutritional counseling.

Signs and symptoms of compulsive overeaters are:

- Fear of not being able to control eating
- Not being able to stop eating
- Isolation, mood swings, depression
- Fatigue, poor sleeping habits
- Eating in secret and hiding food
- Being out of breath after relatively light exercise10)

MEDICAL COMPLICATIONS

Medical complications can frequently be a result of eating disorders. Bowel movements, or urination of individuals with eating disorders who use drugs to stimulate vomiting, can be at risk. This practice also increases the risk of heart failure.

In patients with anorexia nervosa, starvation can damage vital organs such as the heart and brain.

To protect itself, the body shifts into ”slow gear“11): monthly menstrual periods stop, breathing, pulse and blood pressure rates drop, and thyroid function slows.

Nails and hair become brittle (sometimes it even leads to loss of head hair), the skin dries, yellows and becomes covered with soft hair called lanugo. Excessive thirst and frequent urination may also occur. Reduced body fat leads to lowered body temperature and the inability to withstand cold.

Reduced muscle mass also commonly occur in anorexia. If the disorder becomes severe, patients may lose calcium from their bones. That makes them brittle and prone to breakage. Anorexics may also suffer from irregular heart rhythms and heart failure. The most common medical cause of death for people with severe anorexia nervosa is heart disease.

In some patients the brain shrinks and causes personality changes. But fortunately this condition can be reversed when normal weight is reestablished.

Bulimia nervosa patients, even those of normal weight, can severely damage their bodies by frequent binge eating and purging. Purging can result in heart failure and in rare cases, binge eating causes the stomach to rupture. As in anorexia, bulimia can lead to irregular menstrual periods.

Vomiting causes other less deadly, but also serious problems:

The acid in vomit wears down the tooth enamel and can cause scarring on the back of the hand when fingers are pushed down the throat to induce vomiting. Vomiting brings up stomach acid that normally breaks down food.12) And that´s why the loss of enamel and dentin on teeth is a common result of frequent vomiting, as well as numerous cavities.

Alcohol and drug abuse is more common in women with bulimia than it is in the general population or in people with anorexia.In one study of bulimic women, 33 % abused alcohol and 28 % abused drugs. Cocaine and amphetamines were the drugs which are most often abused. In the same study, other types of self-destructive behaviour were common, such as self-cutting and compulsive stealing. It has also been reported that many teenage girls smoke in the belief that it helps to prevent gaining weight.13)

Like persons with anorexia nervosa, many people with bulimia suffer from depression, anxiety and other psychiatric illnesses. These problems place them at an increased risk for suicid.

Compulsive overeaters are usually overweight, so they are liable to the serious medical problems associated with, for example, high cholesterol, high blood pressure and diabetes. They also have a higher risk to develop heart diseases and some types of cancer.

To show the medical complications more clearly, the most important ones are here listed up.

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Of course these medical complications can also be symptoms to help recognize persons with eating disorders.

CAUSES

There are many reasons why people, especially women, develop eating disorders. Causes that trigger eating disorders are for exampel emotional and personality disorders, social ad familiy pressures, etc.

Some experts say that genetics may also play a small role.

People who suffer from any kind of eating disorders often have similar personality traits:

- Low self-esteem
- Feelings of helplessness
- A fear of becoming fat

Eating disorders are frequently developed to deal with stress and anxietis. Persons with anorexia nervosa think they can gain admiration by losing weight and becoming thin.

FAMILY INFLUENCES

Negative factors within the family play a possible role in triggering eating disorders.

Although this ”typical“ family model, which I will now describe, may not be right for all patients, it is common to many.

These families are described as warm and loving on the surface. Mothers of anorexics seem to be over-involved in their child´s life. Mothers of bulimics are often critical and detached.

But also fathers and brothers who are too critical may play a role in the development af anorexia in girls.

Often the whole family is unable to deal with conflicts within the family.

It is also said that parents of anorexics and bulimics have quite often problems with alcohol. As well as, persons with eating disorders have more often been victims of sexual abuse.

SOCIAL PRESSURES

In my opinion social pressure plays an important role in the development of eating disorders. Women should be thin in order to be beautiful.

I think especially in the Western culture this social pressure is enormous.

You can see very thin models, who really look emaciated, on nearly every advertising poster and in every publicity brochure and commercial on television.

These thin models present the ideal of beauty in our time.

In former times when food was rare and women were financially dependant, the ”ideal“ woman was rather plump. And now, when we have more than enough to eat and women are more independant, women should be thin.

On the one hand advertisers promote with these emaciated models weight-reduction programms, for example, but on the other there are lots of ads for junk foods. This seems to me quite paradoxical!

Women want to look like these models, who stand for beauty, success and sexual desireability. So they begin dieting, and this dieting often becomes too extreme and dangerous.

HIGH-RISK-GROUPS:

- Persons who ^were fat in their childhood.
- Actors: They should present the ideal of beauty in order to be successful.
- Athletics
- Gay men, because they normally pay more attention to their figure.

SYMPTOMS

Most of the medical complications, which I have already stated, are also common symptoms of eating disorders. To obtain a general idea I made a chart to list them up:14)

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TREATMENT

Eating disorders are most successfully treated when they are diagnosed early. Eating disorders must be treated by trained therapists. Support groups for the patient, but also for the family and friend, are also often useful.

The major difficulty in treating eating disorders is the fact that especially anorexic patients still believe that their emaciated body is normal or even attractive. Bulimic patients often feel that purging is the only way to prevent obesity.

Some form of psychotherapy is usually needed to help to deal with their illness and emotional problems. Often, a group therapy, in which people who have similar problems can share their experiences, is helpful.

Some doctors hospitalize patients with eating disorders until they are nutritionally stable. If the condition of the patient is life-threatening tube or intravenous feeding is needed. Some other doctors prefer to work with patients in their family setting. I think the aim of the therapy should be to help the patient maintain a normal weight, develop normal eating patterns and overcome unhealthy attitudes concerning the body.

In cases where an eating disorder is accompanied by serious depression, antidepressants are used in therapy.

But an immediate success doesn´t guarantee a permanent cure. Sometimes, even after successful hospital treatment and return to a normal weight, patients may have relapses.A follow-up therapy until three to five years is recommended to become completely cured.15)

If you want to help persons who suffers from an eating disorders, listen to them, tell them that they aren´t alone and be there for them.

But in approaching someone who has an eating disorders you can also make a lot of mistakes.

Don´t say:

”Why are you doing this to me?“ or ”You are ruining your family.“ or ”If you loved me, then you would eat this food.“

If you say that it makes the person feel more guilty and worse.

’’You´ve put on weight, you look great!“

They don´t hear ”you look great“, they only hear ”ou´ve put on weight“ and believe that they are fat.

”You aren´t trying to get better. You´re just getting worse.“

Recovery is a long process and the person will have relapses. These relapses are a normal part of recovery.

’’Nobody is going to like the way you look now.“

A comment like this will only cause more damage. It is better to avoid comments on appearance, especially ones like this.

SOME FIGURES TO EATING DISORDERS

according toAnorexiaNervosa andRelatedEatingDisorders, Incorporated (ANRED)

1 % of female adolescents have anorexia nervosa.

About 4 % at the age between 14 and 22 years suffer from bulimia nervosa. About 50 % who were anorexic develop bulimia or bulimic patterns.

Only about 5 – 10 % of people with anorexia or bulimia nervosa are male.

In my opinion this gender difference shows the reflection of the opposite social expectations for men and women. I think men are supposed to be strong and powerful. They feel ashamed if they have skinny bodies.

Women, on the other hand, are supposed to be tiny, they need to feel protected, and to be thin.

MORTALITY RATES

Without treatment, up to 20 % of people with serious eating disorders die. With treatment, that numer falls to 2 – 3 %.

RECOVERY RATES

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This study indicates that recovery takes between four and nearly seven years. Patients who make only partial recoveries still focus too much on food and weight.

People with these problems tend to be secretive, and they often deny that they even have a disorder. Therefore it is very difficult to know exactly how many people are affected.

INTERVIEW

To achieve a better understanding how eating disorders can be triggered and how people who suffer from an eating disorder feel I want to present an interview. I made the interview with Christina P. from Kirchbichl. In the age of 14 she developed anorexia nervosa. Now she is 27 and mother of a daughter.

C: Everything started because I was suffering from Handschüler Christian. I: What is Handschüler Christian?

C: That´s a kind of cancer. I stayed a long time in hospital because of this disease. After my second chemotherapy I was 20 kilogrammes heavier because of all these medicaments, especially of cortisone. I always felt sick and I couldn´t take food. When I ate something I always vomitted.

I: When you were 20 kilogrammes heavier do you want to become thinner?

C: Not in the beginning. Of course it was hard for me that I was suddenly a fat child. I had always been a tiny and delicate creature. I came out of hospital in summer holidays. In autumn school started. My classmates knew about my disease because my form teacher told them. But the other schollmates didn´t recognize me any more and they teased me.

I: Well, that was really hard for you. How old were you at that time?

C: I was 14 years old. I was always a very bright and lively child. But because of my disease I was often tired and ill on account of lacking resistance. And I wasn´t able to take part in physical education at school.

I: And you still didn´t take food?

C: No, because I wasn´t able to. I shuddered at the thought of eating something. I really forgot to eat.

I: But when did you consciously begin thinking of becoming thinner?

C: At the age of 16 when I became automatically thinner because I stopped taking medicaments. I lost weight but then I wanted to be even thinner. It was no problem for me because I just forgot to eat.

In the end I had only 36 kilogrammes.

I: Did you realize that you had a problem?

C: No, not really.

I: And how did your family realize it?

C: I always had medical supervisions twice a year because of Handschüler Christian and my mother told the doctors about my problem.

I: Were you in hospital?

C: No, I asked to get outpatient treatment and they gave me this chance. I: In the beginning, did you resist the treatment?

C: Yes a little bit, but not really. Because I also didn´t like my appearance any more. I looked like a coat hanger.

I: Did you also get psychological treatment? C: Yes, I had one therapist.

I: Did your family talk with this therapist too? C: Yes.

I: How often did you have to go to hospital?

C: For one year, I went twice a week to hospital in Innsbruck. It was really a hard time for me. It was already hard to gain half a kilo because my body was used to starve. But I wanted to manage it and so after a few months I had 40 – 42 kilogrammes.

I: Did you also have medical complications? C: No, I only had a little bit of hair loss.

I: No problems with your circulation, for example, or dry skin or the feeling of being cold all the time?

C: Yes, I had a low blood pressure – but I still have. And I was often tired and cold, you´re right. But dry skin? – No, I hadn´t.

I: Did you get a follow-up treatment?

C: No, but when I had to go to my medical supervisions concerning Handschüler Christian they also checked my weight.

But I think as a result of the treatment I felt, and I still feel, more energy.

I: Yes, I´ve already read something about that. C: I had an activity and went by bike lots of time. I: Did you do that in oder to lose weight?

C: No.

I: But first you said that you had often been tired. C: Yes, I was, but I although had this activity.

I: Can you say that the disease Handschüler Christian or especially the chemotherapy cause your eating disorder?

C: Yes, because I really wasn´t able to eat something.

But on the other hand it was also the situation within my family. My father often was unfaithful to my mother. When my mother wasn´t at home he telephoned secretly with other women, and so on. I was the only one who has realized that.

I never spoke with my therapist about that.

I: So, you can say that you have dealt with this problem on your own.

C: Yes, that´s right. I think that was sometimes also the reason why I did so much exercise – I wanted to get rid of my aggressions against my father.

I: It´s true then that you had two causes that have triggered your anorexia?

C: Yes, that´s true.

But now I´m recovered, although I still can´t eat very much. When I eat a rather big meal, then I have enough for the whole day.

I think during the divorce of my parents I was liable to have a relapse.

I: Do you think you may have a relapse in the future? C: No, not anymore.

I: Do you now pay attention to your figure?

C: Not really. I try to live in a healthy way. I now have 48 kilogrammes – I´ve always been a rather thin person.

And also during my pregnancy I had no problems. I was never afraid of gaining weight. Two weeks after the birth of my daughter I had already the same figure as before.

I: So, in your case your anorexia had a happy end.

C: Yes, but I think I had neither a true youth nor true childhood.

I: That´s right. I thank you very much for telling me your story. It was really very interesting.

C: No problem. If you have further questions you can ask me any time. I: Thank you!