Eating Disorders - suicide in slow-motion

Within the last few years, the previously unheard-of eating disorders of Bulimia Nervosa and Anorexia Nervosa have received widespread press coverage and public attention as the magnitude of this problem that affects both teens and adults has grown.

Although the causes are not clear, worrying numbers of people -- most of them young women -- develop potentially life-threatening eating disorders. People with bulimia, known as bulimics, indulge in bingeing (episodes of eating large amounts of food) and purging (expelling food by vomiting or using laxatives). People with anorexia, whom doctors refer to as anorectics, severely limit their food intake.

Half of those who are anorexic also have bulimic symptoms. In 1994, about 9,000 people were admitted to hospital and diagnosed with bulimia while about 8,000 were diagnosed with anorexia (estimates by the National Center for Health Statistics). Studies have indicated that by their college freshman year, 4.5 to 18 percent of women and 0.4 percent of men have a history of bulimia and that as many as 1 in 100 females between the ages of 12 and 18 have anorexia.

About 90-95 percent of bulimia and anorexia cases are women and while people of all races develop the disorders, the overwhelming majority of those diagnosed are white.

In most cases, professional help is needed for people to stop their anorexic or bulimic behaviour. Otherwise, the problem may become chronic and cause serious health problems, even death. Sometimes, anti-depressants are prescribed to people with these eating disorders and in 1996, the FDA added the treatment of bulimia to the indications for the antidepressant Prozac (fluoxetine).

The American Anorexia/Bulimia Association says that about 1,000 women die of anorexia each year. More specifically, the National Center for Health Statistics reports that "anorexia" or "anorexia nervosa" was the underlying cause of death noted on 101 death certificates in 1994 and was mentioned as one of multiple causes of death on another 2,657 death certificates. That year, bulimia was noted as the underlying cause of death on two death certificates and mentioned as one of several causes on 64 others.

Theories about the causes of bulimia and anorexia abound. One of them is that the "ideal" portrayed by magazines, movies and television makes some young women feel abnormally pressured to be as thin. The fact that the skinny "waif"-look continues to be highly fashionable, Barbie dolls have literally impossible vital statistics and celebrities like Cher are having ribs removed to achieve an hourglass figure all seems to support this theory.

Another theory is that abnormalities in key chemical messengers in the brain may encourage the development or persistence of these disorders.

The Bulimic
Once begun, the cycles of bingeing and purging (often together with a strict diet) spiral out of control easily. Despite most cases of bulimia developing during the teens or early 20s, many bulimics conceal their symptoms successfully, usually avoiding treatment until middle-age. Actress Jane Fonda revealed that she had hidden her bulimia from age 12 until finally recovering at age 35, reporting that she had binged and purged up to 20 times daily! The late Princess Diana also confessed to being a secret bulimic, saying her disorder was a manifestation of her need for attention and help.

Many bulimics appear healthy and successful (perfectionist), with nearly normal weight. In reality, however, they often suffer from low self-esteem and depression. Bulimics may also exhibit other compulsive behaviour - one doctor reports that a third of his bulimic patients regularly engage in shoplifting while another quarter have abused or been addicted to alcohol at one time or another.

The normal food intake for women and teenagers is 2,000 to 3,000 calories daily. Bulimic binges, however, average about 3,400 calories in fifteen minutes, according to one study. Extreme cases have bulimics consuming up to 20,000 calories in binges lasting 8 hours. Some resort to stealing food or money to support their obsession, which may cost up to $50 a day.

Bulimics purge to lose the weight gained during binges by vomiting, (by self-induced gagging or with an emetic, a substance which causes vomiting) or by using laxatives (50-100 tablets at a time), diuretics (drugs that increase urination), or enemas. Periods of fasting or vigorous exercise often occur between binges.

Excessive/extreme purging quickly upsets the body's balance of sodium, potassium and other chemicals. This may lead to fatigue, seizures, irregular heartbeat and thinner bones. Repeated vomiting can damage the stomach and oesophagus (the tube that carries food to the stomach), make the gums recede and erode tooth enamel (some patients lose all their teeth prematurely. Other side effects include skin rashes, broken blood vessels in the face and irregular menstrual cycles.

The Anorectic
Anorexia can develop at any age, from 5 to 60, although it most commonly develops among teenagers and the occurrence of 8-11 year olds developing the disorder is increasing. Anorexia may be limited to one episode accompanied by large weight loss within a few months followed by recovery, or it may begin gradually and persist for years. The illness may swing between improving and getting worse, or it may just become steadily more severe.

An anorectic's pre-occupation with food is usually accompanied by habits such as moving food about the plate, cutting it into tiny pieces to prolong eating and not eating with the family. Excessive exercise is also another common symptom.

To weight-obsessed anorectics, normal fold of flesh are regarded as "fat" which must be eliminated, fuelled by a compulsive fear of becoming fat. After the normal fat padding is lost, sitting or lying down brings discomfort and not rest, making sleep difficult. As the disorder progresses, victims may withdraw from loved ones and become increasingly isolated.

Faced with starvation, the body slows down or stops various processes. Blood pressure and body temperature falls, breathing rate slows, menstruation stops (or never begins, in the case of pre-teen girls) and the thyroid gland (which regulates growth) displays reduced activity. The skin becomes dry while hair and nails become brittle. Light-headedness, cold-intolerance, constipation and joint swelling are other common symptoms. Soft hair called lanugo forms on the skin for warmth. An extreme imbalance of body chemical may even cause heart failure.

When anorectics also have bulimia, the effects are even worse. The late recording artist Karen Carpenter, an anorectic who used syrup of ipecac to induce vomiting, died after a build-up of the drug irreversibly damaged her heart.

Recovery
Getting treated early is vital. The longer either disorder lasts, the greater and less reversible the damage becomes.

The family is often asked to help in the treatment, which might include psychotherapy, nutrition counselling, behaviour modification and self-help groups. Therapy is usually on an out-patient basis and normally lasts a year or more, unless life-threatening physical symptoms or severe psychological problems demand hospitalisation.

There are presently no drugs approved specifically for bulimia or anorexia but several are being investigated for this use and among them are several anti-depressants. If you think a friend or family member is suffering from bulimia or anorexia, point out in a caring, non-judgemental way the behaviour you have observed and encourage the person to seek medical help.

If you think you may be suffering from either of these disorders yourself, keep in mind that you are not alone and that this is a health problem that requires professional help.As a first step, talk to your parents, family doctor, religious counsellor, school counsellor or nurse.

What is Bulimia Nervosa and Anorexia Nervosa?
According to the American Psychiatric Association, a person must display all of the specific symptoms of that disorder in order to be diagnosed as either bulimic or anorectic.

Anorexia Nervosa
· Refusal to maintain weigh that's over the lowest weight considered normal for age and height
· Intense fear of gaining weight or becoming fat, even though underweight
· Distorted body image
· In women, three consecutive missed menstrual periods without pregnancy

Bulimia Nervosa
· Recurrent episodes of binge eating (minimum average of two binge-eating episodes a week for at least three months)
· A feeling of lack of control over eating during the binges
· 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
· Persistent over-concern with body shape and weight

Information based on "On the teen scene: Eating disorders require medical attention", by Dixie Farley FDA Consumer March 1992 (Permission granted, e-mail message + public domain notification on website)

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