Eating Disorders

Eating disorders affect five to ten percent of adolescent and young adult women. Under the guise of "dieting", many young women are able to mask their symptoms for years. Characterized by preoccupation with food, abnormal eating habits and obsession with self-image, eating disorders can cause serious health problems. Left untreated, severe cases of eating disorders can result in death from starvation, cardiac arrest and suicide. Those who receive early diagnosis and treatment have a better chance of full recovery than those who wait years before seeking help.

Eating disorders are a complex set of behavioral and psychological problems that may result from a desire for control. In the sufferer's mind, eating may be the only area where the individuals feel they have the ability to direct their own lives.

Eating disorders vary in scope and severity and fall into three categories: self-imposed starvation (anorexia nervosa), binge-eating followed by purging (bulimia nervosa) and compulsive over-eating (binge disorder).

Anorexia Nervosa

The most serious eating disorder, anorexia nervosa is diagnosed when an individual weighs at least 15 percent less than normal. Characterized by self-imposed starvation and an extreme dislike for food, anorexia nervosa can cause psychological, gynecological and endocrine problems. In the most severe cases, weight loss can approach one-half of body weight, with mortality rates of 10 to 15 percent.

The incidence of anorexia nervosa appears to be on the rise. Each year, one out of 200 young girls 12-18 years will develop anorexia. While this disorder primarily affects young females, about 6 percent of reported cases are adolescent males and may occasionally be found in children as young as 8 years old, as well as older adults.

Adolescents with anorexia are often described by their parents as "model" children who are obedient at home and high achievers in school. They may be heavily involved in sports such as gymnastics, ballet, cheerleading, wrestling and swimming. In addition, these individuals may be intensely competitive, perfectionists, and rigid thinkers who view life only in black and white terms.

Most anorexics were never obese before their illness. The onset of anorexia typically begins with dieting, which may have been precipitated by a casual remark by a coach or friend that they are "clumsy," "becoming fat" or their performance is "slipping." Societal pressures which equate thinness with achievement, success and popularity may also promote unnecessary dieting.

Regardless of how much weight they lose, anorexics perceive themselves as fat and continue dieting even when they become bone thin. They may hide food, avoid eating with family members, exercise compulsively and wear multiple layers of loose clothing. Their condition may be far advanced before parents become aware of what is happening.

Causes

While the cause of anorexia is still unknown, studies suggest that a variety of psychological, sociological and biological factors may play a role in its development.

Individuals with anorexia tend to share similar psychological characteristics of low self-esteem, feelings of inadequacy, non-assertive behavior and difficulty in managing stress. While family relationships may appear loving and warm on the surface, there are often underlying problems, e.g., overly protective or controlling parents, avoidance of conflict, and excessive involvement in each other's lives. A significant number of anorexics have been victims of sexual abuse or rape.

Anorexia occurs predominantly in industrialized, developed countries. Societies that place excessive value on thinness can lead women to believe that self-worth depends on their body size or appearance. Impressionable adolescents strive to attain the same image that actresses, models and athletes promote in the media.

There may be a biological basis for eating disorders. Recent studies have shown that the neuroendocrine system which regulates many functions, including appetite and digestion, is seriously disturbed in individuals with anorexia. In addition, there is also evidence that after the onset of anorexia, the hypothalamus begins to work improperly, resulting in lower blood pressure and body temperature, hormonal changes and lack of sexual interest.

Treatment

The most urgent concern is getting an individual with anorexia to eat and gain weight. This is accomplished by gradually increasing the daily caloric intake. Weight gain is encouraged in an atmosphere where the individual feels in control.

The psychological effects of anorexia can lead to serious medical problems. In advanced cases, the physical symptoms of starvation may be present (see listing). Treatment should include a complete medical examination to determine the extent of physiological damage that has occurred

Hospitalization for anorexia is indicated when medical problems become severe. In this highly structured setting, food intake and weight are carefully monitored, and meals are eaten under staff supervision. Registered dietitians create special menus to meet individual needs for caloric intake and nutritional requirements.

Individual psychotherapy and family therapy create understanding of the disease process and its effects. Therapy focuses on the relationships with family and friends and the reasons for falling into a pattern of self-starvation. When severe depression is present, the use of antidepressants generally results in rapid behavior improvement. Support groups for anorexics and family members can also help the recovery process.

Bulimia Nervosa

Up to five percent of college women in the U.S. suffer from bulimia nervosa, an eating disorder characterized by recurrent episodes of binge eating followed by purging. The typical eating binge can range from 1,000 to as high as 20,000 calories. Individuals diagnosed with bulimia nervosa average several episodes of binge eating a week for at least three months. To prevent weight gain, bulimics may engage in self-induced vomiting or misuse of medications, such as laxatives, diuretics and enemas. Others may use excessive exercise or fasting to compensate for overeating.

Depression, stress and feelings related to body image seem to trigger binge eating episodes, not extreme hunger. Bulimics feel unable to control their eating habits. They may gulp down their food without taking the time to chew or taste it. After binge eating, bulimics experience a temporary feeling of euphoria which is quickly replaced by shame or guilt from their overeating. Unlike anorexics, bulimics recognize that their eating behavior is abnormal.

Persons with bulimia may be normal, under- or over-weight, making the condition difficult to identify. While their weight may fluctuate dramatically, weight loss is not usually as severe as in individuals with anorexia. Their self-image is closely tied to body weight, with excessive emphasis placed on physical appearance. Approximately 85-90 percent of individuals with bulimia are women.

Left untreated, bulimia can cause many medical problems, including tooth enamel erosion, gastritis, sore throat, dehydration, disruption of menstruation and abnormal heartbeat. In severe cases and without treatment, bulimia nervosa can result in possible death.

Causes

The exact cause of bulimia is unknown, but there are psychological and biological factors that may contribute to its development. Bulimics share common personality traits such as low self-esteem, depression, difficulty expressing emotions and overdependence on others' approval. Other compulsive behaviors such as stealing, promiscuity or substance abuse may also be present. Some individuals with bulimia have borderline personality disorder, which can result in unstable moods, thought patterns, behavior and self-image.

Family relationships and history may also play a role. Substance abuse is more common among family members of bulimics than either anorexics or those without an eating disorder. Research indicates an inherited risk factor for bulimia.

Biological theories suggest that the cycle of binging and purging causes the metabolism to slow down, making the individual more susceptible to weight gain and perpetuating the cycle. Purging through vomiting and the use of laxatives may stimulate the body to produce natural opioids that, in turn, cause addiction to the bulimic cycle. Other experts have discovered that bulimics have a lower amount of serotonin, a condition also found in people with depression and obsessive-compulsive disorder.

Treatment

Treatment for bulimia nervosa involves individual psychotherapy, family counseling, behavior modification and nutritional guidance. Through therapy, individuals gain an understanding of the psychological issues that led to their maladaptive eating behavior. They learn how to manage feelings, enhance self-esteem, improve personal relationships, identify triggers and avoid stress. When depression is present, antidepressant medication in combination with therapy has proven effective. Participation in self-help groups such as Overeaters Anonymous can also be beneficial.

The binging and purging cycle of bulimia can lead to many physical problems. A complete medical examination should be performed upon treatment initiation to determine the extent of any physical damage. Continual vomiting can cause esophageal tears, tooth damage and abnormal heartbeat, among other problems. Hospitalization for bulimia is recommended when medical condition requires stabilization or when eating behavior cannot be controlled in an outpatient setting.

Through behavior modification and nutritional guidance, bulimics learn to normalize eating behavior and change their attitudes about food and body image. After assessment of nutritional status, target goals are set. A food diary may also be part of the treatment plan.

Binge Eating Disorder

Binge eating disorder is probably the most common eating disorder, affecting two percent of all Americans. Individuals with this condition experience frequent, uncontrolled eating, sometimes in secret. Unlike bulimics, they do not engage in purging behavior after an episode of binge eating.

Sufferers experience feelings of disgust, depression, and guilt from their binge eating. Out of shame, they hide their problem from friends and family members. Many people become so preoccupied with their appearance that they avoid social gatherings or begin to miss work or school. They feel embarrassed over the quantity of food they are eating and prefer to eat alone.

Most people with binge eating disorder are obese. They tend to become overweight at a younger age and have more frequent episodes of losing and regaining weight. Attempts to control eating habits on their own are often unsuccessful. For some, strict dieting may even worsen binge eating. This disorder is slightly more common among women.

The medical complications of binge eating disorder are similar to those from obesity -- high blood pressure, diabetes, high cholesterol, gallbladder disease and heart problems, among others.

Causes

About half of individuals with binge eating disorder also have a history of depression. Yet, it is unclear whether depression is the cause or effect of this condition. Many people feel that their binge episodes are triggered by anger, sadness, boredom, anxiety or other negative emotions. Impulsive behavior may be more common in individuals with this condition.

Current research is focusing on how brain chemistry and metabolism may contribute to the development of binge eating disorder.

Treatment

Psychotherapy helps individuals examine relationships with family and friends and identify stressors and situations that trigger binge eating. Cognitive behavioral therapy uses techniques to monitor and change eating behaviors. For some individuals, antidepressant medications may be effective.

We can help

Help for eating disorders begins with excellent diagnosis and treatment. At Dominion Hospital, our mental health professionals have extensive experience in the treatment of eating disorders. Through careful evaluation of medical and psychological history, our experts can determine the most effective treatment approach and identify the appropriate treatment resources, both at Dominion and in the community. For those individuals who require hospitalization for their eating disorders, Dominion provides a highly structured environment where eating behaviors can be monitored and controlled, while addressing their psychological and medical needs.

Dominion offers a complete spectrum of care with varying levels of treatment intensity to meet individual needs. In addition to services for children and adolescents, Dominion Hospital has specialized programs for adults and older adults.