Overview
Eating disorders have increased in frequency as a consequence of society's emphasis and preoccupation with thinness. Eating disorders are multi-factorial, with genetic, traumatic, and nutritional causes. In North America, anorexia nervosa and bulimia nervosa are the two most common eating disorders. They predominantly affect women.
Anorexia nervosa is a psychiatric condition in which people intentionally starve themselves because of a false belief that they are fat, or for fear of becoming obese. In reality, they are almost always underweight or of normal weight when the condition starts. It is estimated that more than 90% of all those diagnosed with anorexia nervosa are women, often from middle and upper socioeconomic backgrounds. This disorder usually starts in the years between adolescence and young adulthood, with the average age at onset of 14 years. Anorexia nervosa afflicts about 1 person out of 100,000 in the population at large, but the rate is believed to be higher among Caucasian adolescent girls, about 1 in 200.
Bulimia nervosa is an eating disorder characterized by uncontrolled or compulsive binge eating, usually followed by inappropriate ways of trying to get rid of the food. Most often, this involves purging by self-induced vomiting or abuse of laxatives, enemas, or diuretics. It's also sometimes called the binge-purge syndrome. Some people with bulimia don't purge, but will overeat (consuming as many as 20,000 calories at one time) and then compensate for binge-eating sessions with other behaviours such as fasting or over-exercising. A person with bulimia may secretly binge anywhere from twice a day to several times daily. In most cases, binge eating is followed by purging. A person with bulimia may use as many as 20 or more laxatives at a time.
Bulimia commonly appears in the latter part of adolescence, between the ages of 18 and 20, but it can develop at an earlier or later age. Like anorexia, bulimia predominantly affects young, Caucasian, middle- and upper-class women. The American Psychiatric Association estimates that between 0.5% and 3.7% of women experience anorexia and between 1.1% and 4.2% experience bulimia at some point in their lifetime. One difference between people with bulimia and anorexia nervosa is that people with bulminia are aware of their problems with food yet they don't feel in control of their condition.
Causes
Eating disorders are generally viewed as being psychological in origin. However, like depression, schizophrenia, and bipolar affective disorder, they are currently believed to have many causes - including genetic and functional changes in the brain. People suffering from anorexia and bulimia have preoccupations with body image, weight, and eating. They also have a distorted personal body image and a fear of fatness and weight gain.
Although cultural factors have an influence on the development of eating disorders, they appear to stem from multiple factors. There's been a lot of debate about the role of faulty parenting and dysfunctional family environments in relation to eating disorders. Genetic and hormonal factors are believed to play significant roles; people with eating disorders are believed to have a genetic predisposition to the illness. Individuals who have a family history of depression, alcohol abuse, obesity, or eating disorders are at higher risk for anorexia nervosa and bulimia. There also appears to be a neurologic relationship between eating behaviour patterns (such as dieting and starvation) and the nervous and hormonal systems, since hunger, food cravings, and feelings of fullness are controlled by certain areas of the brain and involve a number of digestive hormones.
Symptoms
People with anorexia nervosa may appear severely emaciated due to malnutrition, sometimes so severe their ribs can be seen through the skin. Other common symptoms of anorexia include:
- constipation
- dehydration
- depression
- dizziness
- dry, scaly skin
- faintness or weakness
- inability to concentrate
- intolerance to cold
- irritability
- loss of body fat
- low blood pressure
- missed, or absence of, menstrual periods
- psychological fears of obesity and weight gain
- slow heart beat
While most people feel hungry and uncomfortable when their calorie intake is low or restricted, people with anorexia suppress this discomfort and usually lose the ability to appreciate normal hunger cues. As they begin to starve, they may experience a feeling of euphoria, similar to how a runner or jogger gets the well-known "runner's high."
If the onset of anorexia occurs before puberty, a girl's sexual development will stop and menstruation won't begin. Severe anorexia leads to chronic malnutrition, which has damaging effects on the body, especially the thyroid, heart, and digestive and reproductive systems. Anorexia can be fatal. Half of those who die with anorexia die of suicide and half die of medical complications.
Some people with bulimia may experience episodic weight loss, while others maintain a normal weight. In some cases, menstrual cycles may be affected and stop, but menstruation is usually preserved. Possible symptoms of bulimia include:
- dehydration (due to excess use of laxatives or frequent self-induced vomiting)
- tooth decay and erosion (due to the acids that are brought up from severe and constant vomiting)
- low blood pressure
- constipation
- swollen cheek glands (like mumps)
- abnormal hormone levels
- stomach problems
- irregular heartbeat
A variety of complications can result from the constant vomiting. For example, inflammation of the esophagus (called esophagitis) and severe dental problems can occur. At its worst, constant purging can lead to heart damage. People with bulimia may have a history of anorexia or obesity. They may also have psychiatric problems such as depression, anxiety disorders, social phobias, and panic disorder, as well as addictive behaviours like alcohol or drug abuse.
Treatment
People with anorexia rarely seek or want treatment, since they usually don't acknowledge or admit they have a problem. It's often left to family members and friends to recognize the eating disorder and urge them to get treatment.
Anorexia doesn't get better without treatment - people with anorexia need medical and professional help to get better. The biggest obstacle to treating anorexia is the person's unwillingness to undergo treatment.
The primary goal of therapy is to get the person to eat again and gain weight. In general, people with anorexia don't consider their behaviour to be abnormal or unhealthy, so it's very difficult to convince them that they have a serious problem and to get them to eat normally. If the condition is severe, to the point of emaciation, hospitalization is usually necessary.
Counselling, both individual and family, is commonly part of a treatment plan. This involves cognitive behavioural therapy, where patients are counselled about body image issues, weight management, normal eating habits, nutrition, and the effects of starvation. Drug therapy with medications such as antidepressants are only useful for associated problems such as depression, anxiety, or obsessive-compulsive disorder (OCD). About 70% of people who receive therapy in a timely manner will make a full recovery. But in some cases, anorexia becomes a lifelong problem and may require long-term and counselling and management.
People with bulimia usually want and seek treatment, since they recognize their eating disorder is abnormal and is harmful to their health and happiness.
People with bulimia rarely require hospitalization. They're usually treated with a combination of cognitive-behavioural therapy and medications. Antidepressants are often prescribed, which often reduce food craving and binge-eating episodes. Psychotherapy is used to create awareness and to educate about eating patterns and behaviours, as well as to deal with distorted thoughts about body image and weight. Group and family therapy are commonly used to manage bulimia, and are quite effective. As with anorexia, people with bulimia who get early and prompt treatment will have a full recovery and suffer minimal long-term ill effects.
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Other tips:
To diagnose eating disorders, doctors generally only need signs and symptoms based on a physical exam and a detailed medical or personal history. In the case of a person with anorexia, continued weight loss at a low or normal weight, obsessive exercise, progressive food restriction, falling grades at school or work productivity, and depression should raise suspicion. The diagnosis of anorexia nervosa is made medically when the person's weight has dropped to at least 15% below the minimum normal weight for their age and height due to a pathological fear of obesity. Blood tests reveal abnormalities in hormone levels that help confirm the diagnosis for both anorexia and bulimia. However, there is no test that is diagnostic and the diagnosis of anorexia is made by clinical assessment.
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