Eating Disorders

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An individual suffering with Anorexia Nervosa has a very low body weight caused by self-imposed starvation. In women this can also result in cessation of menstrual periods. Those with Bulimia Nervosa engage in a pattern of binge-eating episodes followed by inappropriate and harmful compensatory behaviors such as self-induced vomiting, abuse of laxatives and/or diuretics, and excessive exercise. Bulimics are usually of normal or slightly above average weight. The underlying link between anorexia and bulimia is that both conditions are characterized by an overriding preoccupation with body size and shape.

As with almost all mental disorders, the cultural context plays a significant role in these two disorders. Individuals living in industrialized societies are bombarded with messages from the media promoting the idea that, particularly for women, being thin is not only essential to physical beauty but is also the key to romantic and financial success as well. This helps to explain why 90 percent of those with eating disorders are female.

Anorexia Nervosa:

For those with Anorexia Nervosa, the goal of maintaining a thin body becomes the very centerpiece of existence, a value that takes precedence over everything else, including health, survival, sex, and even being beautiful. It is critical to recognize the symptoms of anorexia early because terrible outcomes are much more easily prevented with prompt intervention. Unfortunately, awareness of the problem by friends and family is only half the battle. Many people with this condition are either unable or unwilling to acknowledge that their bodies are vanishing, despite the alarm expressed by everyone around them and the unmistakable drop on the scale.

A characteristic of this disorder is denial and an unfortunate inability to see the dangers before it is too late to respond to them. Of the people with Anorexia Nervosa who are followed over a sufficient period of time, up to 20% die as a result of their disorder.

The DSM-IV specifies two subtypes of Anorexia Nervosa - Restricting and Binge-Eating/Purging. Those with the Restricting type diet to limit their caloric intake; in the Binge-Eating/Purging type, they reply on purging. Unlike individuals with Bulimia, the Binge-eating-purging anorexic binges on relatively small amounts of food and purges more consistently, in some cases each time she eats. Approximately half the individuals who meet the criteria for Anorexia engage in binge eating and purging.

DSM-IV Criteria for Anorexia Nervosa:

Early signs may include withdrawal from family and friends, increased sensitivity to criticism, sudden increased interest in physical activity, anxiety or depressive symptoms.

A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).

B. Intense fear of gaining weight or becoming fat, even though underweight.

C. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

D. In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration.)

Bulimia Nervosa:

Individuals with Bulimia Nervosa cannot help their eating any more than an alcoholic can control his drinking. Binge eating episodes alternate with frantic efforts to get rid of calories - paying for the bingeing by vomiting, using laxatives, fasting or constant exercising. The dilemma arises from the contradiction that the bulimic cannot control her caloric intake, but wants to control her weight. If body shape was not an issue, the unrestrained binge-eating would lead to obesity. But bulimics care very much about their body weight and shape and are engaged in a desperate attempt to neutralize the effects of the binges in order to avoid gaining weight. This leads to its own vicious cycle.

An episode of binge-eating is like a feeding frenzy. The individual consumes huge amounts of food, often to the point of actual physical pain. Then they may vomit and start all over again. When the binge is over, the bulimic usually feels disgusted and embarrassed, and this is one of the reasons bingeing is often done while alone and is kept secret from friends and family.

Self-induced vomiting is by far the most commonly used compensatory behavior. Some people may prefer the use of enemas and laxatives and a few add diuretics. These compensatory behaviors serve both to alleviate the fear of gaining weight and to restore a desperately needed feeling of control. Sometimes the act of purging becomes an end unto itself and relieves anxiety or actually becomes pleasurable in its own right.

There are two subtypes of Bulimia Nervosa, depending on the compensatory method used to counteract the impact of the binges. The Purging type involves the use of self-induced vomiting or the abuse of laxatives, diuretics or enemas. The Nonpurging type is for those who use fasting and excessive exercise to counteract the weight-gaining effects of a binge. People with the Purging type of Bulimia, approximately 2/3 of those with the disorder, are more apt to show signs of depression and are even more preoccupied with their body image than those who do not purge.

DSM-IV Criteria for Bulimia Nervosa:

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

* eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances

* a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.