Eating disorders

Eating disorders are psychological conditions that involve either overeating, voluntary starvation, or both. The best-known eating disorders are probably anorexia nervosa, anorexic bulimia, and obesity. Researchers are not sure what causes eating disorders, although many believe that family relationships, biochemical (physical) abnormalities, and society's preoccupation with thinness all may contribute to their onset.

Eating disorders are virtually unknown in parts of the world where food is scarce. They also are rarely seen in less prosperous groups in developed countries. Although these disorders have been documented throughout history, they have gained attention in recent years. This attention has come, at least in part, because some famous people have died as a result of their eating disorders.

Young people are more likely than older people to develop an eating disorder. The condition usually begins before the age of 20. Although both men and women can develop the problem, it is more common in women. Only about 5 percent of people with eating disorders are male. In either males or females, eating disorders are considered serious and potentially deadly health problems. Many large hospitals and psychiatric clinics have programs designed especially to treat these conditions.

Anorexia nervosa

The word anorexia comes from the Greek adjective anorektos, which means "without appetite." But the problem for people with anorexia is not that they aren't hungry. They starve themselves out of fear of gaining weight, even when they are severely underweight. The anorectic's self-image is so distorted that he or she sees himself or herself as "fat" even when that person looks almost like a skeleton. Some anorectics refuse to eat at all; others nibble only small portions of fruit and vegetables or live on diet drinks. In addition to fasting, anorectics may exercise strenuously to keep their weight abnormally low. No matter how much weight they lose, they always worry about getting fat.

This self-imposed starvation takes a heavy toll on the body. Skin becomes dry and flaky. Muscles begin to waste away. Bones stop growing and may become brittle. The heart weakens. With no body fat for insulation, the anorectic has difficulty staying warm. Downy hair starts to grow on the face, back, and arms in response to lower body temperature. In women, menstruation stops and permanent infertility may result. Muscle cramps, dizziness, fatigue, even brain damage and kidney and heart failure are possible. An estimated 10 to 20 percent of people with anorexia die, either as a direct result of starvation or by suicide.

Researchers believe that anorexia is caused by a combination of biological, psychological, and social factors. They are still trying to pinpoint the biological factors, but they have discovered some psychological and social triggers of the disorder. Many people with anorexia come from families in which parents are overprotective and have unrealistically high expectations of their children. Also, the condition seems to run in families, which leads researchers to believe it may have a genetic basis. Anorexia often seems to develop after a young person goes through some stressful experience, such as moving to a new town, changing schools, or going through puberty. Low self-esteem, fear of losing control, and fear of growing up are common characteristics of anorectics. The need for approval, combined with American culture's idealization of extreme thinness, also are believed to contribute to the disorder.

The obvious cure for anorexia is eating. But that is typically the last thing a person with anorexia wants to do. It is unusual for the person himself or herself to seek treatment. More commonly, a friend, family member, or teacher initiates the process. Hospitalization, combined with psychotherapy and family counseling, is often needed to control the condition. Force-feeding may be necessary if the person's life is in danger. About 70 percent of anorexia patients who are treated for about six months

A woman suffering from anorexia nervosa. (Reproduced by permission of

Photo Researchers, Inc.

)

return to normal body weight. About 15 to 20 percent can be expected to relapse, however.

Anorexic bulimia

Anorexic bulimia gets its name from the Greek term boulimos, meaning "great hunger," or, literally, "the hunger of an ox." The condition is commonly known simply as bulimia. People with bulimia go on eating binges, often gorging on junk food and then forcing their bodies to get rid of the food, either by making themselves vomit or by taking large amounts of laxatives.

Like anorexia, bulimia results in starvation. But there are behavioral, physical, and psychological differences between the two conditions. Bulimia is much more difficult to detect because people who have the disorder tend to be of normal weight or may even be overweight. They tend to hide their habit of binge eating followed by purging by vomiting or using laxatives. In fact, bulimia was not widely recognized, even among medical and mental health professionals, until the 1980s.

Unlike anorectics, bulimics are aware that their eating patterns are abnormal, and they often feel remorse after a binge. For them, overeating offers an irresistible escape from stress. Many suffer from depression, repressed anger, anxiety, and low self-esteem, combined with a tendency toward perfectionism. About 20 percent of bulimics also have problems with alcohol or drug addiction, and they are more likely than nonbulimics to commit suicide.

Many people overeat from time to time but are not considered bulimic. According to the American Psychiatric Association's definition, a bulimic binges on enormous amounts of food at least twice a week for three months or more.

Bulimics plan their binges carefully, setting aside specific times and places to carry out their secret habit. They may go from restaurant to restaurant, to avoid being seen eating too often in any one place. Or they may pretend to be shopping for a large dinner party, when actually they intend to eat all the food themselves. Because of the expense of consuming so much food, some resort to shoplifting.

During an eating binge, bulimics favor high-carbohydrate foods, such as donuts, candy, ice cream, soft drinks, cookies, cereal, cake, popcorn, and bread, consuming many times the amount of calories they normally would consume in one day. No matter what their normal eating habits, they tend to eat quickly and messily during a binge, stuffing the food in their mouths and gulping it down, sometimes without even tasting it. Some bulimics say they get a feeling of euphoria during binges, similar to the "runner's high" that some people get from exercise.

The self-induced vomiting that often follows eating binges can cause all sorts of physical problems, such as damage to the stomach and esophagus, chronic heartburn, burst blood vessels in the eyes, throat irritation, and erosion of tooth enamel from the acid in vomit. Excessive use of laxatives can be hazardous, too. Muscle cramps, stomach pains, digestive problems, dehydration, and even poisoning may result. Over time, bulimia causes vitamin deficiencies and imbalances of critical body fluids, which in turn can lead to seizures and kidney failure.

Some researchers believe that bulimia, as well as other types of compulsive behavior, is related to an imbalance in the brain chemical serotonin. The production of serotonin, which influences mood, is affected by both antidepressant drugs and certain foods. But most research on bulimia focuses on its psychological roots.

Bulimia is not as likely as anorexia to reach life-threatening stages, so hospitalization usually is not necessary. Treatment generally involves psychotherapy and sometimes the use of antidepressant drugs. Unlike anorectics, bulimics usually admit they have a problem and want help overcoming it. Estimates of the rates of recovery from bulimia vary widely, with some studies showing low rates of improvement and others suggesting that treatment usually is effective. Even after apparently successful treatment, however, some bulimics relapse.

Obesity

A third type of eating disorder is obesity. Obesity is caused by excessive overeating. Being slightly overweight is not a serious health risk. But being severely over one's recommended body weight can lead to many health problems.

Doctors do not entirely agree about the definition of obesity. Some experts classify a person as obese whose weight is 20 percent or more over the recommended weight for his or her height. But other doctors say standard height and weight charts are misleading. They maintain that the proportion of fat to muscle, measured by the skinfold pinch test, is a better measure of obesity.

The causes of obesity are complex and not fully understood. While compulsive overeating certainly can lead to obesity, it is not clear that all obesity results from overindulging. Recent research increasingly points to biological, as well as psychological and environmental, factors that influence obesity.

In the United States, people with low incomes are more likely to be obese than are the wealthy. Women are almost twice as likely as men to have the problem, but both men and women tend to gain weight as they age.

In those people whose obesity stems from compulsive eating, psychological factors seem to play a large role. Some studies suggest that obese people are much more likely than others to eat in response to stress, loneliness, or depression. As they are growing up, some people learn to associate food with love, acceptance, and a feeling of belonging. If they feel rejected and unhappy later in life, they may use food to comfort themselves.

Just as emotional pain can lead to obesity, obesity can lead to psychological scars. From childhood on, many obese people are taunted and shunned. They may even face discrimination in school and on the job. The low self-esteem and sense of isolation that typically result may contribute to the person's eating disorder, setting up an endless cycle of overeating, gaining more weight, feeling even more worthless and isolated, then gorging again to console oneself.

People whose obesity endangers their health are said to be morbidly obese. Obesity is a risk factor in diabetes, high blood pressure, arteriosclerosis (hardened arteries), angina pectoris (chest pains due to inadequate blood flow to the heart), varicose veins, cirrhosis of the liver, and kidney disease. Obesity can cause complications during pregnancy and in surgical procedures. Obese people are about one-and-one-half times more likely to have heart attacks than are other people. Overall, the death rate among people ages 20 to 64 is 50 percent higher for the obese than for people of normal weight.

Since compulsive eating patterns often have their beginnings in childhood, they are difficult to break. Some obese people get caught up in a cycle of binging and dieting—sometimes called yo-yo dieting—that never results in permanent weight loss. Research has shown that strict dieting itself may contribute to compulsive eating. Going without favorite foods for long periods makes people feel deprived. They are more likely, then, to reward themselves by binging when they go off the diet. Other research shows that dieting slows the dieter's metabolism. When the person goes off the diet, he or she gains weight more easily.

The most successful programs for dealing with overeating teach people to eat more sensibly and to increase their physical activity (exercise) to lose weight gradually without going on extreme diets. Support groups and therapy can help people deal with the psychological aspects of obesity.