Eating Disorders

Anorexia Nervosa

A Taste of History

For over one hundred years, people have suffered from a treacherous eating disorder known as anorexia nervosa. Although this disease has existed for many years before, it was not classified until 1873 by Sir William Gull as a central disorder. Causes and effects of this disease are constantly being researched because it consumes the lives of so many people, and not just women. Right now, however, American citizens have a pretty clear idea of the disorders and society’s influence on the anorectic person. Interestingly enough, evidence proves that the disease began to develop centuries ago.

Throughout the middle ages, a larger body for women was surprisingly favorable; it indicated being well fed and capable of bearing children. As time progressed, the impact of femininity developed. The trend shifted toward large breasts, hips, and buttocks. During the 18th century in England it was at one point a law that women could have a waste size no larger that 16 inches. In the 1900s, the obsession of thin waist grew to the point where women resorted to food deprivation, enemas, and purging. Additionally, fashion encouraged women to use wire bodices and bustles in order to embellish the hourglass figure of a woman.

As technology grew in the 20th century, women developed their body ideals through watching movies and seeing models. For the time, slenderness reached its peak in 1926, when flappers were around and the line of a woman’s dress was straight. Ladies received the message that if you weren’t " pencil thin," you didn’t fit in. Although full figured role models surfaced in the 1940s and 50s, an almost emaciated female physique reappeared in the 1960s, which is best exemplified by a 5’6", 92 pound British model named Twiggy.

People began to see the dangers of this obsession with thinness, and due to widespread media attention, groups emerged, devoting their time to the prevention of the disease. For instance, Vivian Meehan founded the National Association of Anorexia and Associated Disorders. Famous faces have also reported to have eating disorders, including tennis-star Zina Garrison, and TV show host, Oprah Winfrey. Karen Carpenter shocked thousands when she died of a heart attack at age 32 in 1982, due to anorexia nervosa. While many others athletes and stars have admitted to the dangers they faced, thousands still continue to battle with the disease.

In the 1990 survey of 800 colleges by the NCAA, it was reported that 93% of the colleges responded that at least one female had an eating disorder, and even men admitted to having a problem, particularly wrestlers. This is somewhat understandable, considering that if a wrestler is one pound over his weight class, he can’t compete in that match. Also, the 48% of female gymnasts that have disorders might justify their problem by saying that weighing less means higher scores. But what about the thousands of average Americans that battle anorexia? What are the factors in their life that ultimately bring them face to face with death?

A man named Richard Morton described in 1689 cases of "nervous consumption." The symptoms he listed were quite similar to today’s accepted definition of anorexia nervosa. It is simply defined as self-starvation, due to a psychological will to be thin. Many people begin to starve as a means of losing first a couple of pounds, but often, the deprivation of food turns into a power that has control over the person, who finds that even after she has reached her original weight goal, she is still not satisfied with her body. According to medical standards of the American Psychiatric Association, a patient will be clinically anorectic if she is 15% less than her normal body weight and hasn’t menstruated in three months. These are only the physical qualifications. Additionally, the anorectic feels fat and is unwilling to gain weight, even when she is very thin. The last two factors are key roles in determining anorexia because the disease has long been agreed to be primarily psychological.

Before the consequences of self-starvation are discussed, one must investigate the elements of the anorectic’s life that triggered such behavior. The roles of society and sports have already been discussed. Through observing countless numbers of thin models, women have also gotten the idea that they would be more popular, beautiful and happy if they were skinny. Nonetheless, society is just the tip of the iceberg in influencing people’s potential for becoming anorectic. The typical anorectic comes from a middle or upper-class family and is a perfectionist. Her parents are likely to have a job that promotes moral values, such as a teacher or a doctor. She is normally an overachiever, which may be where her parents are at fault. When a parent over-inflates their child’s confidence, any blow—no matter how small—to the ego of a high achiever can cause self esteem levels to plummet.

However, contrary to their motivation, some parents deliberately express unhappiness with how their child looks. Some make it no secret that they feel their child is fat, and these are the families who get wrapped up in a concern with dieting. Even worse, some parents of anorectics have histories of drug or alcohol abuse, or they suffer depression. Furthermore, it is proven that a large number of child abuse and rape cases exist in anorectics. This is why therapists deeply explore the childhood of their anorectic patients. Eventually, a person experiences so much anarchy in their personal life that they develop the fear of being too fat.

Whether or not the crash dieters are overweight, they begin their endurance of denying hunger with most normally a positive attitude. They develop in their minds the perfect body which means, in turn, the perfect life. Anxiously they await the compliments they will receive on their new, thin bodies. Hunger is denied, and a test of will power is made. Ritualistic patterns are set, such as eating in secrecy or cutting up food and moving it around on their plates. As they look forward to conquering self-shame of eating " too much," food replaces all other thoughts in the brain. In one such case, a teen-aged student constantly calculated the calories she was consuming in the margins of her homework. Proud feelings arise when the anorectic starts to lose weight, and sufferers anticipate the "safety" that awaits them.

However, once family and friends begin to intervene, the victim’s positive outlook diminishes. Anorectics deny their hunger and begin to separate from family and friends. They spend more time to themselves, and when confronted, they become extremely irritable and annoyed. As they spend more time by themselves, however, they begin to wonder if they are wrong about their actions. Compulsive neatness and exercise takes over for a while, but then severe depression surfaces. Just as they had once felt guilty of eating, they now feel guilty of not being able to resume eating normally. Anxiety increases and stress hits them ten times harder than the average person.

At first, only fatigue, lethargy and dizziness confront anorectics. In early stages, there is a cessation of menstruation, the skin becomes pale, muscles cramp and the stomach bloats. Some other symptoms include tingling in the hands and feet, constipation, and bags under the eyes. Soon, blood pressure drops, breathing slows, and activity of the thyroid gland decreases. Still, most of these symptoms are not visible.

As time passes skin becomes gray and dry, and hair and nails become brittle. An obvious intolerance to cold appears, along with the body temperature decreasing. Soft hair called lanugo forms on the skin for warmth. While on the outside, skin becomes dark and scaly, even worse things happen within the thinning body. Muscles eventually waste away, and normal fat folds disappear. Kidney stones and bladder infections may find their way I the lives of severe cases. Anorectics may begin to develop amnesia and the loss of the ability to reproduce. Internal organs shrink and may begin to bleed. Eventually, if the patients are not treated, kidney failure and heart failure can cause death in the people that have withered away to skin and bones.

Bulimia Nervosa

In contrast to anorexia nervosa, bulimia nervosa is an eating disorder that has only been classified twenty or thirty years ago. Bulimia is a disorder in which its sufferers binge or consume large amounts of food, and then rid their bodies of this food by purging. Purging may be done by induced vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. In addition to these two symptoms, a bulimic may diet excessively between bingeing episodes.

Bulimia usually develops when the person starts to diet. In order to maintain a normal body weigh yet still have the satisfaction of eating and feeling full, the dieter will resort to bingeing and purging. In a bingeing episode, a person will consume about 3000 to 4000 calories within a period of 1 ¼ hours. (The average daily caloric intake is 2500 calories). Typically, the bulimic will feel a lack of self-control during his or her binge, and some may even feel they are "punishing" themselves for feeling hungry by overeating. After he or she feels uncomfortably full, guilt and feelings of disgust will set in, and the bulimic feels no other alternative but to rid themselves of excess calories. All of this behavior is done in secret.

Purging can be achieved by several means. Most bulimics begin by inducing vomiting. Normally, bulimics will vomit by gagging--sticking their fingers down their throats and hitting a reflex that will cause them to throw up. However, some will vomit with the aid of an emetic, a substance that causes vomiting. Others resort to the use of laxatives, or drugs that cause excessive bowel movements. Some people will intake 50 to 100 tablets at a time. Additionally, diuretics, drugs that increase urination, and enemas may be used. Between binges, one may fast or exercise excessively.

Bulimia nervosa patients may retain a normal body weight, but they can still do severe damage to their bodies by frequent by binge eating and purging. In severe cases, death can be a result. Binge eating can cause the stomach or esophagus to rupture. Purging can result in heart failure because of a loss of sodium, potassium and other chemicals. Additionally, fatigue, dizziness, seizures, irregular heartbeat, and thinner bones can result. Vomiting can cause other less deadly, but serious, problems. Stomach acid that comes up can wear down tooth enamel and cause the throat to bleed. Lungs can become inflamed if food particles become lodged in there. Muscle spasms and kidney disease are caused by chronic loss of body fluids. Salivary glands may enlarge, causing puffy cheeks. Puffy eyelids, watery or blood-shot eyes, skin rashes, bruises on the backs of hands, and broken blood vessels in the face are also symptoms of bulimia. In girls, irregular menstrual cycles may exist; in boys, impotence in later life may be a result. These are only physical symptoms of the disease.

Since bulimia nervosa is primarily a psychological disease, there are many other characteristics of the disease as well. Shame, guilt, and depression are dominant feelings. Other psychological disorders can surface, including anxiety, personality disorders, and obsessive compulsive disorders. Some bulimics struggle with addictions such as drug and alcohol abuse. Many resort to compulsive shoplifting to support their habit (Sometimes a bulimic spends $50.00 a day on food). Even when they want to stop their strange habits, bulimics will keep their problem a secret because they are afraid no one will understand their behavior.

Bulimia usually begins during adolescence, and it can develop in both sexes, although it primarily exists in girls. Because "bingeing and purging" is done secretly and most bulimics do maintain a normal weight, they can successfully hide their problem for years. Many do not seek help till their mid-thirties or forties because they are so ashamed. By this time, the habit has become deeply ingrained and harder to change. Fortunately, help is available to people with both topes of disorders. If you or someone you know has an eating disorder, it is vital to get treatment as soon as possible.

Medical classifications of Anorexia nervosa and bulimia nervosa:
(According to the American Psychiatric Association)

Anorexia nervosa:

1) Refusal to maintain weight that is over the lowest weight considered normal for age and height.
2) Intense fear of gaining weight or becoming fat, even when severely underweight.
3) Distorted body image.
4) In girls, three consecutive messed menstrual periods (not due to pregnancy

Bulimia nervosa:

1) Recurrent episodes of binge eating. (minimum average of two episodes a week for a period of at least three months.)
2) a feeling of lack of control over eating during the binges.
3) Regular use of one or more of the following to prevent weight gain: self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise.
4) Persistent over-concern with body shape and weight.

Who’s at risk?

Mark the following statements that apply to determine if you , a friend, or a relative has an eating disorder:
1) Even though people say I’m thin, I feel fat.
2) I get anxious if I can’t exercise.
3) I worry about what I will eat.
4) If I gain weight, I get anxious and depressed.
5) I feel guilty when I eat.
6) I get anxious when people watch me eat.
7) I’d rather die than be fat.
8) I’d rather eat by myself than with family or friends.
9) I don’t talk about my fear of being fat because no one seems to understand.
10) I have a secret stash of food.
11) When I eat, I’m afraid I won’t be able to stop.
12) I lie about what I eat.
13) I get anxious when people urge me to eat.
14) Sometimes I think my eating or exercising is not normal.

If you checked:

1-3 statements: Some preoccupation
4-6 statements: Reason for concern. See your doctor.
7 or more: You are in danger. Make an appointment with your doctor immediately.

Treatment for Both Disorders:

Treatment for anorexia and bulimia is very important; in other words, the sooner the better. The longer the person has the disorder, the more difficult it is to overcome and change the effects on the body. In severe cases, long-term treatment may be needed.

The first step to treat a suspected eating disorder is a complete physical examination to rule out other possible illnesses. Next, the doctor will determine if the patient needs hospitalization, depending on whether they are in severe medical danger. Hospitalization will be needed if there is rapid, excessive weight loss, serious metabolic disturbances, clinical depression, severe binge eating and purging, or psychosis. However, most patients with an eating disorder can receive outpatient treatment.

People with an eating disorder need a comprehensive treatment plan that may involve a variety of experts. To help deal with the illness and underlying emotional issues, some form of psychotherapy is needed. A psychiatrist or psychologist meets with the patient individually to provide emotional support as he or she begins to cope with the illness. Additionally, group therapy may prove to be beneficial, especially with bulimics. Here, people with the same problem can relate to each other and see that they are not alone. Two other forms of therapy that may be helpful are cognitive-behavioral therapy and family therapy. In family therapy, other family members can learn to understand what the patient is going through and may work on dealing with other problems that may be occurring at home and adding to the eating disorder. Cognitive-behavioral therapy teaches patients learn to change eating behaviors by rewarding or modeling wanted behavior.

Additional forms of treatment include the use of medications, which are more commonly used for bulimics. However, they can also be helpful for anorexics when combined with other forms of treatment. Finally, physicians may treat related medical complications, and nutritionists advise diet and eating regimens. Because of drastic changes in metabolism, a person with an eating disorder might have to consume more calories or follow a special diet until they can successfully maintain a normal weight.

If you are a friend or relative of a person suffering from anorexia or bulimia, you play an important role in their healing. Encourage them to get help and stay in a treatment program. Show you care and try to understand what he or she is going through. Sometimes the sufferer may just need you to lend an ear or offer a shoulder to cry on. To better understand the problem, you can read as much as possible. Many brochures, magazine articles, and books discuss both anorexia and bulimia. You can also call hospitals to find out about eating disorders clinics or doctors who specialize in treatment of eating disorders.

If you are an anorectic or bulimic yourself, do not be afraid to get help. As hard as it may be to admit to having any problem, it is best to do research and learn to find out if you have an eating disorder. Most likely if you do have an eating disorder, you will feel that your behavior is strange, and that may hinder your getting help. However, by reading books, you may be able to better face your problem. Additionally, many school programs and local clinics offer either low-cost or free, 100% confidential counseling that you can seek without even your parents finding out. On the contrary, you may want to strongly consider telling your parents or someone else you trust; this may take a strong burden off of your back.