According to the NIMH, dieting plays a role in the onset of two serious eating disorders—anorexia nervosa and bulimia. Preteens, teens, and college-age women are at special risk. In fact, most of those who develop an eating disorder are young women. However, between 5 percent and 15 percent of people with anorexia or bulimia and about 35 percent of those with binge-eating disorder are male, according to the NIMH. No one knows exactly how many men and teenage boys are afflicted. Until recently, there has been a lack of awareness that eating disorders can be a problem for males, perhaps because men are more likely to mask the symptoms of eating disorders with excuses and rationales such as preventing heart disease or diabetes or trying to build a more muscular physique.
Anorexia Nervosa
Anorexia nervosa involves severe weight loss—a minimum of 15 percent below normal body weight. People with anorexia literally starve themselves, although they may be very hungry. For reasons that researchers do not yet fully understand, people with anorexia become terrified of gaining weight. Both food and weight become obsessions. They often develop strange eating habits, refuse to eat with other people, and exercise strenuously to burn calories and prevent weight gain. Individuals with anorexia continue to believe they are overweight even when they are dangerously thin.
The medical complications of anorexia are similar to starvation. When the body attempts to protect its most vital organs—the heart and the brain—it goes into "slow gear." Monthly menstrual periods stop, and breathing, pulse, blood pressure, and thyroid function slow down. The nails and hair become brittle, and the skin dries. Water imbalance causes constipation, and the lack of body fat causes an inability to withstand cold temperatures. Depression, weakness, and a constant obsession with food are also symptoms of the disease. In addition, personality changes may occur. The victim may have outbursts of anger and hostility or may withdraw socially. In the most serious cases, death can result.
Bulimia
The person who has bulimia eats compulsively and then purges (gets rid of the food) through self-induced vomiting; use of laxatives, diuretics, strict diets, fasts, or exercise; or a combination of several of these compensatory behaviors. In 2001 the NIMH reported that based on community surveys, between 2 percent and 5 percent of Americans engage in binge eating, and about half of those with anorexia will turn to bulimia. Bulimia often begins when a young person is disgusted with the excessive amount of "bad" food consumed and vomits to rid the body of the calories.
Many people with bulimia are at a normal body weight or higher because of their frequent binge-purge behavior, which can occur from once or twice a week to several times a day. Those people with bulimia who maintain normal weights may manage to keep their eating disorders secret for years. As with anorexia, binge-eating disorder usually begins during adolescence, but many people with bulimia do not seek help until they are in their thirties or forties.
Binge eating and purging is dangerous. In rare cases, bingeing can cause stomach ruptures, and purging can result in heart failure because the body loses vital minerals. The acid in vomit wears down tooth enamel and the stomach lining and can cause scarring on the hands when fingers are pushed down the throat to induce vomiting. The esophagus may become inflamed, and glands in the neck may become swollen.
People with bulimia often talk of being "hooked" on certain foods and needing to feed their "habits." This addictive behavior carries over into other areas of their lives, including substance (alcohol and drug) abuse. Many people with bulimia suffer from comorbidities such as severe depression, which increases their risk for suicide.
Causes of Eating Disorders
People with bulimia and anorexia seem to have different personalities. Those with bulimia are likely to be impulsive (acting without thought of the consequences) and are more likely to abuse alcohol and drugs. People with anorexia tend to be perfectionists, good students, and competitive athletes. They usually keep their feelings to themselves and rarely disobey their parents. People with bulimia and anorexia share certain traits: they lack self-esteem, have feelings of helplessness, and fear gaining weight. In both disorders, the eating problems appear to develop as a way of handling stress and anxiety.
The person with bulimia consumes huge amounts of food (often junk food) in a search for comfort and stress relief. Yet the bingeing brings only guilt and depression. However, the person with anorexia restricts food to gain a sense of control and mastery over some aspect of his/her life. Controlling one's weight seems to offer two advantages—the victim can take control of her or his body and can gain approval from others.
Demographics of Eating Disorders
Individuals with eating disorders usually come from white middle-or upper-class families. The NIMH noted that although eating disorders have increased substantially in industrialized countries since the 1980s, they are almost unheard of in developing countries. Thinness is not necessarily admired among all people throughout the world, especially in countries where hunger is not a matter of choice.
Treatment of Eating Disorders
Many people with anorexia deny their illness, and getting and keeping patients with anorexia in treatment can be difficult. Treating bulimia also can be difficult. Many people with bulimia want to leave treatment if their symptoms are not quickly relieved.
Generally, a physician treats the medical complications of the disease, whereas a nutritionist advises on specific diet and eating plans. To help the patient face his or her underlying problems and emotional issues, psychotherapy is usually necessary. Group therapy has been helpful for people with bulimia, who often are relieved to find that they are not alone or unique in their binge-eating behaviors. A combination of behavioral therapy and family therapy is often the most effective with people with anorexia. However, if patients do not have success with these methods, an antidepressant such as an SSRI may help relieve the symptoms associated with anorexia and bulimia, according to a study in the August 2000 American Journal of Psychiatry (vol. 157, no. 8).
A long-term study (approximately 11.5 years) of 173 young women diagnosed with bulimia reiterated the strong hold that eating disorders have on their victims (P. K. Keel, et al., "Long-Term Outcome of Bulimia Nervosa," Archives of General Psychiatry, vol. 56, January 1999). At the final follow-up, 30 percent of the patients still showed symptoms of eating disorders. Eighteen percent were diagnosed with "eating disorder not otherwise specified," 11 percent with bulimia, and 1 percent with anorexia nervosa.
Of the 70 percent in remission, one-third had achieved only partial remission. Patients who had longer periods of symptoms before beginning treatment and those who had a history of substance abuse were less likely to be successful. The results of this study underscore the observation that the earlier the eating disorder is diagnosed and treated, the more likely the patient will recover to a healthy weight.
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