Eating Disorders

Eating disorders are dangerous psychological (relating to the mind) illnesses that affect millions of people, especially young women and girls. The most widely known eating disorders are anorexia nervosa and bulimia nervosa, which will be discussed further in this chapter.

Officially recognized by the medical community only since 1980, eating disorders were first brought to the public's attention when pop singer Karen Carpenter (1953–83) died from complications resulting from anorexia. People suffering from eating disorders battle life-threatening obsessions with food and unhealthy thoughts about their body weight and shape. If untreated, these disorders can lead to death. Researchers have found many factors that are probable causes of eating disorders. Recovery from an eating disorder is possible, though it is a difficult process that should not be done alone. The first steps toward recovery are for the sufferer to accept that there is a problem and to show a willingness to focus on his or her feelings rather than on food and weight.

This chapter will discuss the types of eating disorders that have been identified, the causes, the consequences of an eating disorder on the mind and body, and the treatment and prevention of eating disorders.

TYPES OF EATING DISORDERS AND THEIR CHARACTERISTICS

Anorexia Nervosa

Anorexia nervosa is a condition in which a person refuses to maintain a healthy body weight (persons whose weight is at least 15 percent below their normal body weight might fall into this category). The term anorexia nervosa means literally "nervous lack of appetite." However, this name is misleading as people with anorexia do not lack an appetite; rather, they battle hunger every day. Anorectics, as people who suffer from anorexia are referred to, are extremely afraid of gaining weight or becoming what they perceive to be fat.

Typically, what accompanies this fear of becoming fat is an anorectic's faulty perception of her body. Some anorectics may realize that they are indeed thin but will still view a particular part of their bodies, such as the stomach or thighs, as being fat and out of proportion. In fact, an anorectic's self-esteem is closely tied to this distorted view of her body. Continued weight loss is considered by anorectics to be a sign of achievement and self-discipline while any weight gain, even if it brings them closer to a healthy body weight, is considered a sign of weakness or a lack of self-control.

Anorexia is often difficult to diagnose and treat because of the secretive nature of this illness. Anorectics are usually good at concealing their self-starvation with excuses, or they may even engage in purging (vomiting) if forced to eat. Furthermore, anorectics will often wear heavy clothes that both camouflage (hide) their excessive weight loss from others and keep them warm. (Due to their dangerously low weight and lack of insulating body fat, anorectics are often cold.)

In addition to avoiding eating whenever possible, anorectics will often display high levels of energy that seem at odds with their frail physical conditions. Anorectics may also develop odd oral habits, including chewing gum throughout the day, drinking an excessive amount of coffee or diet soda, and chain-smoking. Finally, many anorectics become obsessed with food, despite their unwillingness to consume any.

Bulimia Nervosa

Bulimia nervosa means literally "ox hunger." This term is appropriate on many levels as bulimia is characterized by a repeated cycle of binge eating and purging. A binge is when an individual eats, in a particular period of time, an abnormally large amount of food. (Of course, this doesn't refer to special occasions, such as holiday meals, when it is acceptable to eat more than usual.)

The binge is then followed by an episode of purging. Purging is when a person gets rid of the food that she has eaten by either making herself vomit, taking an excessive amount of laxatives (drugs that induce bowel movements), diuretics (drugs that expel water from the body through urination), or enemas (a process that expels waste from the body by injecting liquid into the anus), or engaging in fasting and/or excessive exercise. People with bulimia, known as bulimics, engage in such behaviors at least two times a week for a period of six months or more.

A particularly stressful event or depression often triggers an episode of binge eating, intense hunger that follows restricted food intake, or a variety of feelings tied to body weight, body image, and food. The binge eating may temporarily relieve a bulimic's feelings of depression or stress, but often deeper feelings of depression, disappointment, and anxiety may follow. This will then trigger an episode of purging. Many bulimics report feeling out of control when bingeing and use similar terms to describe their need to purge their bodies of the food they just consumed.

Pop singer Karen Carpenter, who died from complications as a result of anorexia at the age of 30. (

AP/Wide World Photos

. Reproduced by permission.)

Bulimics, like anorectics, are usually ashamed of their behavior and will attempt to hide their illness from others. Because of this and the fact that many bulimics maintain a normal body weight, it is often hard to recognize that a person is, in fact, bulimic.

Many bulimics suffer from low self-esteem and may even have suicidal thoughts. Often they are rigid perfectionists who think in absolutes ("I am bad because I ate that"). Like anorectics, bulimics will make negative statements about their appearance and experience extreme guilt over eating even normal portions of food. They will begin to withdraw from social activities, particularly those that will make it difficult for them to purge without suspicion.

Other Types of Disordered Eating

There are those individuals whose behavior does not fall under the categories of anorexia or bulimia; rather, these people can exhibit a wide range of disordered eating and unhealthy weight management symptoms. Since they cannot be diagnosed as anorexic or bulimic, these individuals will typically receive a diagnosis of an "eating disorder not otherwise specified." An example of disordered eating includes a person of normal weight who eats no fat and occasionally purges. She would not be considered bulimic because she is not bingeing, and she also is not anorectic because she is not dangerously underweight. She would therefore be diagnosed with an eating disorder not otherwise specified.

Eating disorders are often difficult to diagnose and treat because of the secretive nature of these illnesses. (Photograph © 1995

Science Photo Library/Custom Medical Stock Photo

. Reproduced by permission.)

There are other disorders, such as binge-eating disorder and exercise addiction, that are not yet official psychological diagnoses but which are becoming more and more prevalent. These problems are often diagnosed as "eating disorder not otherwise specified" as well. They often occur in conjunction with anorexia and bulimia. However, they can also occur independently of other disordered eating and may soon have their own official diagnoses.

BINGE-EATING DISORDER. Like bulimia, binge-eating disorder involves repetitive episodes of binge eating in a restricted period of time over several months. This illness is different from bulimia, however, because people suffering from binge-eating disorder do not purge after a binge. This disorder has more to do with an absolute lack of control over eating than with the conciliatory acts (purging) that follow a bulimic's binge.

Binge eaters will eat very rapidly, usually until they are uncomfortably full. They will eat big portions of food even if they are not actually hungry. Because of this, many binge eaters engage in binges secretively as they are embarrassed by how much they have eaten and feel guilty and depressed following these episodes. Similar to the binges experienced by bulimics, binge eaters report that depression and anxiety usually trigger their binges. During the binge itself, sufferers often feel out of control or disconnected from their actions.

Binge eaters usually suffer from obesity (being very overweight). Furthermore, many have been "yo-yo" dieters (experiencing large fluctuations in weight from a cycle of dieting) their entire lives. Both of these effects can cause binge eaters to feel worse about their inability to control their eating habits. (Not everyone who is obese suffers from binge-eating disorder. Rather, obesity must be paired with certain behaviors for it to be evidence of binge-eating disorder.)

Christy Henrich, a competitive gymnast, died in 1994 after a long battle with two eating disorders that had reduced her weight to just 60 pounds. (

AP/Wide World Photos

. Reproduced by permission.)

Other signs of binge-eating disorder can include food disappearing from cabinets and cupboards at a rapid rate, or even finding an excessive amount of food wrappers concealed under someone's bed or in her trash. The consumption of odd foodstuffs such as raw cookie dough or condiments can also point to binge-eating disorder.

EXERCISE ADDICTION. Exercise addiction, or compulsive exercise, seems like a strange term as most people consider exercise to be good for their health. Exercise is a fun way to relieve stress and increase energy levels. It releases endorphins (the body's natural painkillers, which make people feel good after exercising). However, when a person's interest and participation in exercise activities are taken to extremes, exercise can turn into an addiction that must be performed each day; the act of exercising provides that person with a temporary high. If an exercise-addicted person cannot exercise, he or she will experience a great deal of guilt and anxiety over the inactivity.

Exercise-addicted individuals will exercise to the detriment of everything else in their lives. Someone who is addicted to exercise will exercise with serious physical injuries, pass up opportunities to spend time with loved ones in favor of exercise, and even miss work or school to spend time exercising. Depression, low self-esteem, and repressed anger are all characteristics of exercise-addicted individuals because no matter how much they exercise or achieve in other areas of their lives, they believe they should do more.

Because some sports demand a certain body type (such as gymnastics or ice skating) or depend on how much a person weighs (such as wrestling or horse racing), exercise addiction often develops in elite athletes like dancers, ice skaters, gymnasts, jockeys, and wrestlers, in their quest to perform the best in their sport. Exercise addiction can also be linked to those suffering from anorexia or bulimia because they feel unsatisfied with their bodies and think excessive exercise can help them get thin. Bulimics will often use compulsive exercise as a method of purging.

CAUSES OF EATING DISORDERS

A number of factors contribute to the development of eating disorders. Some are biological and genetic in nature, while others are a direct result of the cultural and familial environment in which an individual is raised.

Biological Factors

There are factors contributing to the development of eating disorders that are biological, or genetic. For example, if a person has a relative in her immediate family with an eating disorder, she is at a higher risk to develop an eating disorder.

Additional biological factors contributing to disordered eating can be triggered by the initial act of starving, binge-eating, or purging. This is because these behaviors can change an individual's chemical balance, particularly brain chemistry. Starvation and overeating lead to the production of brain chemicals that induce feelings of peace and euphoria (happiness). These good feelings mask feelings of anxiety and depression, both of which are commonly experienced by people suffering from eating disorders. This has caused certain researchers to conclude that some people with eating disorders use (or do not use) food as a relief when they are feeling poorly about themselves.

Of note is the fact that certain researchers believe that depression, which is also genetic, can be the cause of an eating disorder. (See section on depression later in this chapter.)

Psychological Factors

People suffering from eating disorders share many of the same personality traits. For example, eating-disordered people lean toward being perfectionists. Furthermore, many of them suffer from feelings of low self-esteem, despite their accomplishments and perfectionist ways. Extremist thinking, too, is present in many people with eating disorders. These individuals assume that if being thin is "good" then being even thinner is better. This leads to the thought that being the thinnest is the absolute best; it is this thinking that pushes some anorectics to plummet to body weights of fifty or sixty pounds.

Often, people who live with eating disorders have no sense of self. They simply do not feel that they know who they are or what their place in the world is. An eating disorder, however, offers a sense of identity to these individuals in that it enables them to say, "I am thin," and "I am dieting." This eventually leads them to define themselves solely on their appearance and their dangerous actions rather than with positive, healthy accomplishments.

Social Factors

Eating disorders, in general, occur primarily in industrialized societies, such as the United States, Australia, Canada, Europe, and Japan. In all of these places, the media (TV, movies, magazines) bombard people with the virtues and importance of being thin. It is endlessly implied in television

Many people with eating disorders have a distorted view of their bodies, seeing themselves as overweight when, in fact, they are not. (Photograph by

Robert J. Huffman. Field Mark Publications

. Reproduced by permission.)

shows, movies, and advertisements that thinness will bring a person success, power, approval, popularity, friends, and romantic relationships. Women, in particular, are held to an almost-impossible-to-achieve standard of physical fitness and beauty, the height of which is being slender and thin. (In fact, female fashion models now weigh an average of 25 percent less than an average

To match the proportions of a Barbie doll, a woman with a normal shape (left) would have to transform her height, waist, and bust to appear like the figure on the right. (Photograph by

Jill Greenberg

© 1996. Reprinted with permission of

Discover Magazine

.)

woman.) Because of these media messages, and correlating comments from young women about their weight and body shape, a link between eating disorders and social pressures can be established.

Family Factors

People are shaped in part by their experiences with their families. Families contribute to an individual's emotional growth. If someone is raised in a dysfunctional family, she may have feelings of abandonment and loneliness. Certain families have dynamics in which rigidity, overprotectiveness, and emotional distance are commonplace. If parents make all of a child's decisions for her, when she gets to adolescence and needs to make decisions for herself, she may find she doesn't have the tools to do so. All of these dynamics can promote the development of eating disorders in the future.

Families in which unrealistically high expectations are placed on the children can also lead these individuals to develop disordered eating. The disordered eating is used as a way to cope with feelings of inadequacy and as a way to control at least one area of their lives. Children also receive their first messages about their bodies from their families. If parents place too much emphasis on physical appearance, it can lead to low self-esteem in those children, placing them at risk for developing eating disorders when they are older.

Most children learn their eating habits and food preferences from their families. Often times, cleaning one's plate or not eating too much or even parents' close control of what their child eats can lead to disordered eating later in life. Parents' attitudes toward food and their own bodies greatly affect children's attitudes toward food and how they will feel about themselves.

FAMOUS PEOPLE WHO HAVE BATTLED EATING DISORDERS

Actress Ally Sheedy. (

AP/Wide World Photos

. Reproduced by permission.)

Paula Abdul, Singer

Justine Bateman, Actor

Karen Carpenter, Singer*

Nadia Comaneci, Gymnast

Susan Dey, Actor

Diana, Princess of Wales

Jane Fonda, Actor/Activist

Zina Garrison, Tennis Player

Tracy Gold, Actor

Heidi Guenther, Ballet Dancer*

Margaux Hemingway, Actor

Christy Henrich, Gymnast*

Daniel Johns, Musician

Kathy Johnson, Gymnast

Gelsey Kirkland, Ballet Dancer

Lucy Lawless, Actor

Gilda Radner, Actor/Comic

Cathy Rigby, Gymnast

Joan Rivers, Comic

Ally Sheedy, Actor

* indicates death resulting from the eating disorder

Triggers

Triggers are items or events that spark the beginning of other events. Eating disorders are often triggered by an event or a circumstance in the life of an individual who is already prone to developing such a condition. A period of adjustment, such as leaving home to attend summer camp, prep school, or college, can easily trigger disordered eating in an individual with such tendencies already in place. A traumatic event in someone's life, such as sexual abuse, can also trigger the development of an eating disorder. Other triggers can seem harmless yet represent large life changes, such as moving, starting a new school or job, graduation, and even marriage. Whatever the trigger is, it is usually closely tied to the end of a valued relationship or a feeling of loneliness.

The most common trigger of an eating disorder, however, is dieting. Very often dieting can lead people to disordered eating of some sort, including anorexia or bulimia.

THE PHYSICAL AND PSYCHOLOGICAL CONSEQUENCES OF EATING DISORDERS

An eating disorder can have serious physical and psychological consequences. How serious these consequences are depends on how early an eating disorder is identified and treated. With help, the effects of an eating disorder can be treated; however, if an eating disorder is left untreated for years, some of the effects are irreversible and life-threatening. For these reasons, early detection and treatment is essential and can save a person's life.

The different types of eating disorders are often connected. In fact, 30 to 50 percent of people with anorexia exhibit signs of bulimia as well. Therefore, the consequences of the disorders are also connected. In other words, bulimia and anorexia often share physical, as well as psychological, consequences.

How Anorexia Nervosa Affects the Body

Anorexia causes many physical problems. For instance, it upsets the normal functions of hormones. For girls, this means the body is unable to produce enough of the female hormone estrogen because it does not have enough fat. This will cause an absence of menstrual cycles, called amenorrhea. For boys, anorexia causes a decrease in the production of the male hormone testosterone, which results in a loss of sexual interest.

An anorectic body lacks the protective layer of fat it needs to stay warm. To compensate for the lack of fat, lanugo (fine hair) will grow all over the body to keep it warm. Another problem anorexia causes is a decrease in bone mass. The body needs calcium for strong bones. Since an anorectic is not eating enough food, which is the source of calcium, the body's bones suffer and weaken. Later in life, this could result in a dangerous bone disease called osteoporosis.

Additionally, without the fuel it needs, an anorectic's body will respond as if it is being assaulted and begins to fight back in order to survive. To survive the body must have energy, but because the body has no food to turn into energy, it seeks out the muscles, and eventually, the organs (heart, kidney, and brain) for sustenance—often causing permanent damage to the organs in the process. This is the most serious consequence of anorexia and can possibly lead to cardiac arrest and/or kidney failure, both of which can result in death.

How Bulimia Nervosa Affects the Body

The frequent purging that occurs with bulimia does serious damage to the body. Self-induced vomiting can severely damage the digestive system. Repeated vomiting also damages the esophagus (throat) and eventually it may tear and bleed. Vomiting brings stomach acids into the mouth, causing the enamel on the teeth to wear away. As a result, the teeth may become weakened and appear ragged. There will also be an increase in cavities from vomiting.

Other consequences include swollen salivary glands, which gives some bulimics the appearance of having chipmunk cheeks, and cuts and sores on the knuckles from repeatedly sticking one's fingers down the throat to induce vomiting (known as "Russell's sign"). Stomach cramps and difficulty in swallowing are also common.

If laxatives (drugs that induce bowel movements) are abused, constipation will result because the body can no longer produce a bowel movement on its own. Abuse of laxatives and diuretics (drugs that expel water from the body through urination) can also cause bloating, water retention, and edema (swelling) of the stomach. Because the body is constantly being denied the nutrients and fluids it needs to survive, the kidneys and heart will also suffer. Specifically, a lack of potassium will result in cardiac abnormalities and possible kidney failure, which can also result in death.

How Binge-Eating Disorder Affects the Body

The physical effects of binge eating are not as severe as with anorexia and bulimia, namely because the body is not denied food or put through the painful process of purging. Nevertheless, there are some potentially serious consequences for binge eaters.

Since binge eaters may suffer from obesity, health complications such as diabetes or heart problems can develop. Health problems from yo-yo dieting can include hypertension (high blood pressure) and long-term damage to major organs, such as the kidney, liver, heart, and other muscles.

How Exercise Addiction Affects the Body

Many anorectics and bulimics exercise compulsively (constantly) in order to lose weight. Compulsive exercise is extremely dangerous and can cause many painful injuries, including stress fractures, damaged bones and joints, as well as torn muscles, ligaments, and tendons. Even worse, the injuries may become more serious as many compulsive exercisers will continue their routines despite their injuries.

When an eating disorder is successfully treated, the body can heal and return to normal. Sometimes, however, the eating disorder has continued for so many years that there is too much damage for a full recovery to occur. A person may have to live with a weak heart or kidney for the rest of her life. A woman may be unable to conceive a child because her reproductive system cannot function properly (due to the absence of menstruation). Also, a person may have to live with the debilitating bone disease osteoporosis.

How Eating Disorders Affect the Mind

The psychological consequences of an eating disorder are complex and difficult to overcome. An eating disorder is often a symptom of a larger problem in a person's life. The disorder is an unhealthy way for that person to cope with the painful emotions tied to the problem. For this reason, the emotional problems that triggered the eating disorder in the first place can worsen as the disorder takes hold.

An eating disorder can also cause more problems to surface in a person's life. Eating disorders make it difficult for people to perceive things normally because certain chemical changes take place when the body is deprived of nutrients. As a result, the body relies on adrenaline (a hormone that is normally released during times of stress and fear) instead of food for energy. Adrenaline naturally makes makes someone excited, which makes it more difficult to deal with painful emotions.

Research has shown that many people suffering from an eating disorder also suffer from other psychological problems. Sometimes the eating disorder causes other problems, and sometimes the problems coexist with the eating disorder. Some of the psychological disorders that can accompany an eating disorder include depression, obsessive-compulsive disorder, and anxiety and panic disorders.

In addition to having other psychological disorders, a person with an eating disorder may also engage in destructive behaviors as a result of low self-esteem. Just as an eating disorder is a negative way to cope with emotional problems, other destructive behaviors, such as self-mutilation, drug addiction, and alcoholism, are similar negative coping mechanisms.

Not everyone who has an eating disorder suffers from additional psychological disorders; however, it is very common. For this reason, psychological counseling is an essential part of recovery (see Chapter 15: Mental Health Therapies).

DEPRESSION. Depression is one of the most common psychological problems related to an eating disorder. It is characterized by intense and prolonged feelings of sadness and hopelessness. In its most serious form, depression may lead to suicide (the taking of one's own life). Considering that an eating disorder is often kept a secret, a person who is suffering feels alienated and alone. A person may feel that it is impossible to openly express her feelings. As a result, feelings of depression will worsen the effects of an eating disorder, making it difficult to break the cycle of disordered eating.

Feelings of depression will worsen the effects of an eating disorder, making it difficult to break the cycle of disordered eating. (Photograph by

Robert J. Huffman. Field Mark Publications

. Reproduced by permission.)

With counseling and support, it is possible to combat these negative feelings and prevent them from progressing over time. Recently, doctors have begun to prescribe antidepressant drugs, such as Prozac, to address the problems of depression resulting from an eating disorder. Prozac can help ease feelings of depression, which in turn gives a person better tools with which to fight an eating disorder. [For more information on depression, see Chapter 12: Mental Illness.]

OBSESSIVE-COMPULSIVE BEHAVIOR. Obsessions are constant thoughts that produce anxiety and stress. Compulsions are irrational behaviors that are repeated to reduce anxiety and stress. People with eating disorders are constantly thinking about food, calories, eating, and weight. As a result, they show signs of obsessive-compulsive behavior. If people with eating disorders also show signs of obsessive-compulsive behavior with things not related to food, they may be diagnosed with Obsessive-Compulsive Disorder (OCD).

Some obsessive-compulsive behaviors practiced by eating disorder sufferers include storing large amounts of food, collecting recipes, weighing themselves several times a day, and thinking constantly about the food they feel they should not eat. These obsessive thoughts and rituals worsen when the body is regularly deprived of food. Being in a state of starvation causes people to become so preoccupied with everything they have denied themselves that they think of little else.

FEELINGS OF ANXIETY, GUILT, AND SHAME. Everyone experiences feelings of anxiety (fear and worry), guilt, and shame at some time; however, these feelings become more intense with the onset of an eating disorder. Eating disorder sufferers fear that others will discover their illness. There is also a tremendous fear of gaining weight.

As the eating disorder progresses, body image becomes more distorted and the eating disorder becomes all-consuming. Some sufferers are often terrified of letting go of the illness, which causes many to protect their secret eating disorder even more.

Eating disorder sufferers have a strong need to control their environment and will avoid social situations where they may have to be around food in front of other people or where they may have to change their behavior. The anxiety that results causes people with eating disorders to be inflexible and rigid with their emotions.

Bulimics and binge eaters, specifically, experience guilt and shame with their disorders. This is mainly because, unlike anorectics, they are not usually in denial and they do realize that there is a problem. Bulimics will feel anxiety before, during, and after a binge and can only relieve this anxiety through purging. Purging, however, brings on overwhelming feelings of guilt and shame.

Binge eaters also feel anxiety during a binge, but because they do not purge, they feel ashamed over their lack of control around food.

EATING DISORDERS AND OTHER DESTRUCTIVE BEHAVIORS

Drug Addiction and Alcoholism

It is common for people with eating disorders also to struggle with drug and alcohol addiction. In fact, research shows that one-third of bulimics have a substance-abuse problem, particularly with stimulants (drugs that excite the nervous system) and alcohol. This may stem from the fact that people with eating disorders have difficulty coping with their emotions and use negative means, such as drugs, to mask their problems. Drugs and alcohol provide temporary escapes from reality but, similar to eating disorders, can progress into serious problems that require treatment to overcome. [For more information on drug addiction and alcoholism, see Chapter 14: Habits and Behaviors.]

Self-Mutilation

Self-mutilation is practiced by many eating disorder sufferers. It is also known as self-inflicted violence (SIV) or "cutting." The most common forms of self-mutilation include cutting, burning, head-banging, hitting, and biting oneself. The reasons people self-mutilate stem from an inability to handle overwhelming feelings or a state of emotional numbness. Many sufferers explain that they hurt themselves in order to distract themselves from emotional pain because it is easier to deal with physical pain than to address uncomfortable emotions, such as fear or anger. They may also hurt themselves in order to feel something which gives them an escape from feelings of loneliness. [For more information on self-mutilation, see Chapter 14: Habits and Behaviors.]

EATING DISORDERS AND SEXUALITY

Eating disorders often develop around puberty, when the body is changing and maturing. This time of change can produce anxiety and confusion for both boys and girls because puberty is the beginning of sexual maturity. Girls develop breasts, start menstruating, grow taller, and develop more body hair. Boys' sexual organs (the penis and testicles) grow. Boys also grow taller, get more body and facial hair, and develop bigger muscles.

The sexual feelings that accompany puberty are new, and what they are feeling or experiencing may embarrass some young people. When someone is suffering from an eating disorder, issues surrounding sexuality can become even more complicated. Some people may seek out sexual relationships to feel close to someone and ease feelings of isolation. Others may avoid sexual relationships altogether because they feel ashamed of their bodies.

In some cases, an eating disorder is triggered by sexual abuse (when a person is forced to engage in sexual activities against his or her will). In these instances, an eating disorder sufferer is usually acting out in response to a painful event. She may gain or lose weight in an attempt to make herself sexually undesirable. She may avoid sexual relations as a way to take control over her body and prevent painful feelings from resurfacing. The anger and distrust felt toward the opposite sex may result in complete rejection of the opposite sex. On the other hand, some eating disorder sufferers may have many sexual partners in an attempt to erase the past and gain acceptance from the opposite sex.

TREATMENT AND RECOVERY FROM EATING DISORDERS

Treatment and recovery go hand in hand. It is very hard to stop an eating disorder without any treatment. Recovery is a long process in which an eating disorder sufferer may have to enter treatment more than once. Some people may even try different kinds of treatment programs during their recovery until they find one that works for them.

There may be obstacles to starting treatment. The fear of becoming fat and losing control, which drives most eating disorders, is very strong and hard to eliminate. Also, an eating disorder sufferer may be in denial about her condition and may be unwilling to consider treatment. These feelings may be based on a fear of letting go of the illness that she feels is part of her identity. The eating disorder sufferer must learn to refocus her thoughts from food and weight to her emotions so that she can deal with what is really bothering her. Since many feelings that need to be addressed have been buried by the disorder, professional counseling is important for a successful recovery.

In order for treatment to work, a person must be ready to be treated. Some sufferers may even say they are ready but really are not. They may pretend to change their attitude about food, but they are still starving themselves or bingeing and purging their food secretively. If a person does not fully commit to a treatment program, she will most likely continue suffering from the deadly illness even after completion of the program.

Treatment Basics

Treatment programs vary in the approach that they take. An eating disorder sufferer needs to find a program that best suits her and her condition. A program may work for one person but be ineffective for another. It is important that the person feels comfortable with and believes in the treatment.

Treatment usually begins with an assessment by a physician or mental health counselor. Depending on the severity of the eating disorder, the sufferer will either enter an inpatient or outpatient program. Inpatient programs, or hospitalization, are for the most severe cases. To be hospitalized, the sufferer is usually at a critical point in her illness where her life is in danger or she may have strong suicidal thoughts. Outpatient programs are conducted at a facility or doctor's office that the patient visits while still living at home.

Whether the program is inpatient or outpatient, it will usually include various forms of counseling and medical care to treat the physical effects of the illness. The most common forms of counseling include nutrition, individual, family, and group. Nutrition counseling teaches the patient about healthy eating habits and designs appropriate meals. Its goal is to slowly bring the sufferer's weight back up to a safe level that can be easily maintained without dieting or provoking obsessive behavior about food. The first few months of treatment for anorectics can be very dangerous if the eating disorder has gone on for a long time. This is due to the shock the body experiences from eating food after years of starvation.

Individual counseling is one-on-one counseling in which a therapist helps the sufferer deal with her emotions and take control of her body and life again. Family counseling is when the family of the eating disorder sufferer is involved. This type of counseling helps the family and the sufferer to establish better relationships and change any unhealthy dynamics of the family. In group counseling, a counselor leads meetings of a group of eating disorder sufferers to help them learn how to achieve and maintain strong relationships. It also helps sufferers learn that they are not alone.

In support groups, eating disorder sufferers meet to offer support, understanding, and hope to one another as they battle their disorders. Support groups, like group counseling, help sufferers to not feel so alone in their illnesses and learn from others' experiences.

Some eating disorder sufferers will be prescribed medication to ease depression and anxiety as part of their treatment.

[For more information on types of treatments and therapy, see Chapter 15: Mental Health Therapies.]

The Recovery Process

Recovery is not easy. Most eating disorder sufferers feel that they are not worthy of love or life. It takes time (months, even years) and a lot of support from friends, family, and medical professionals to change the sufferers' self-perceptions. They need to feel worthy again of love from others. However, recovery is not as simple as saying "I love you" to eating disorder sufferers. They need to build their self-esteem so that they can believe that they deserve the love of others. Some people are able to make an initial recovery, but many find recovery to be an ongoing, lifelong process.

An eating disorder sufferer has certain goals, both physical and psychological, that she needs to try to reach in recovery. The physical aims should include the ability to eat a variety of healthful foods (without bingeing and purging) and maintain a healthy weight. Females should start their menstrual periods either for the first time or again without the help of medication.

The psychological aims of recovery should include a noticeable decrease in the fear of food and becoming fat as well as the ability to establish strong relationships with family and friends again. Another goal should be to realize the role society and the media play in furthering disordered thinking about people's weights and body shapes. This realization will help sufferers learn to accept and like their bodies without having to live up to unrealistic standards of beauty and thinness. An eating disorder sufferer should also work to establish new, positive coping skills and engage in activities that do not involve food or weight control.

The goals for recovery should start small. Learning to meet modest goals first will provide a sense of accomplishment that will help push a person toward meeting larger goals. It is easy to become overwhelmed and fall back into familiar patterns of living. Eating disorder sufferers have taught themselves how to starve or binge and purge and are familiar with using the disorder to help them cope with life. They need time to relearn healthy eating habits and how to feel good about themselves again at a healthy weight.

PREVENTING EATING DISORDERS

Many eating disorder organizations focus on prevention in their programs. That is, stopping eating disorders before they even start. The belief is that awareness and education can go a long way in preventing the onset of these painful illnesses, which can become lifelong struggles. Many eating disorder experts promote teaching prevention at a young age since eating disorders usually begin in adolescence, although there are reported cases of eating disorders starting in children as young as eight years old.

There are a few main objectives that eating disorder organizations focus on in their prevention programs. These objectives help to provide people with the tools they need to cope with the problems that may contribute to an eating disorder.

Prevention means:

• reordering thoughts on food and weight
• focusing on health
• understanding the dangers of dieting
• developing a positive body image
• rebelling against cultural and media messages that encourage unhealthy behaviors
• explaining why fat is not the enemy
• helping to end fat discrimination

Reordering Thoughts about Food and Weight

Since there is enormous pressure to be thin in many cultures, including the United States, many people are dissatisfied with how they look, believing that they are inadequate and unworthy of affection or love. As a result of a negative body image, many people go on strict diets and believe that food is the enemy. However, the body needs food to survive and going on restrictive diets will only lead to an intense preoccupation with food, calories, and weight.

The first step in preventing the development of eating disorders is to reorder feelings and thoughts about food and weight. Eating disorder experts recommend that people reject unhealthy messages about weight, body shape, and diet. Since body shape and weight are determined mostly from genetics, there is only so much a person can do to control or change weight and body shape. Trying to fight against or change the body's set point (the weight at which one's body naturally falls) is unhealthy and possibly dangerous because it creates a cycle of yo-yo dieting. Research has shown that while not every diet leads to eating disorders, 80 percent of eating disorders are initially triggered by a diet. [See Chapter 1: Nutrition, for more information on body set point.]

DEVELOPING A POSITIVE BODY IMAGE

Developing a positive body image is necessary to the prevention of eating disorders. Many people struggle with this issue and must work hard at accepting their bodies. Eating disorder experts emphasize the importance of exercising for health reasons rather than for burning calories and losing weight. The same experts also recommend becoming politically active in the fight against unhealthy cultural messages because it can be a source of positive feelings and empowerment.

Other suggestions include:

• Avoid negative talk about food and weight.
• Avoid referring to foods as "good" or "bad."
• Don't participate in weight-loss programs or experiment with weight-loss products.
• Exercise moderately; don't engage in unhealthy or excessive exercise programs.
• Talk about body-image issues with close friends and family.
• Don't criticize people for gaining weight.
• Don't compliment people for losing weight.
• Encourage family and friends to question cultural attitudes about weight and body shape.

Fat and Fit? The Obesity Question

Many people have been taught to fear fat, which leads to unhealthy dieting and intense struggles to lose weight. This thinking is based on the assumption that being fat is unhealthy and should therefore be avoided at all costs.

Now, however, many researchers are questioning the idea that being fat automatically puts a person at risk for health problems. The New England Journal of Medicine published an article in 1998, edited by Jerome P. Kassirer, M.D. and Marcia Angell, M.D., that confirms what many researchers have already suspected: treatments for obesity do not work, obesity treatments pose serious health risks, and the treatments are not justified because the health risks of obesity are not as high as once thought.

Some researchers claim that obesity is dangerous to one's health when combined with a sedentary (non-active) lifestyle. It is possible to be fat and healthy. In fact, how healthy a person is depends more on how much a person exercises rather than how much a person weighs. Weight alone is not a proper indication of how healthy a person is, and it is more beneficial for a person to concentrate on fitness instead of fatness.

FOR MORE INFORMATION

Books

Bode, Janet. Food Fight: A Guide to Eating Disorders for Pre-Teens and Their Parents. New York: Simon and Schuster, 1997.

Cooke, Kaz. Real Gorgeous: The Truth About Body and Beauty. New York: W.W. Norton, 1996.

Hornbacher, Marya. Wasted: A Memoir of Anorexia and Bulimia. New York: HarperCollins, 1998.

Kolodny, Nancy. When Food's a Foe: How You Can Confront and Conquer Your Eating Disorder. Boston: Little Brown & Co., 1992.

Krasnow, Michael. My Life as a Male Anorexic. New York: Haworth Press, 1996.

Sacker, Ira M. Dying to Be Thin: Understanding and Defeating Anorexia Nervosa and Bulimia—A Practical Lifesaving Guide. Warner Books, 1987.

Web sites

Eating Disorders Information. [Online] http://eatingdisorders.about.com (Accessed November 1, 1999).