What
are we talking about, exactly? (anorexia and bulimia defined)
What are the causes of eating
disorders?
What symptoms should I look
for?
Binge eating disorder
How do I avoid eating
disorders?
How do I get better?
What do I do if I think my friend
may have an eating disorder?
What would you say is more important to
you: being healthy, or being thin? Or do you
think that being thin equals being healthy? Are you
on a diet? Do you think you need to be? Are
there situations in your life where you feel you have no
control but desperately wish you did? You may or may
not fit into an eating disorder category such as anorexia
or bulimia, but many people have some degree of disordered
eating. A person crosses over into an eating disorder
when her desire to control her weight ends up controlling
her.
Eating disorders are a serious disease with serious consequences
that develop slowly over time. It is a struggle that
is difficult to overcome alone, and that's why you don't
have to do it by yourself!
What
are we talking about, exactly? [back
to top]
Anorexia is an eating disorder that consists
of choosing to starve yourself, and it is life-threatening.
It is not just choosing not to eat, but choosing not to
keep a healthy weight. This disease is motivated by
a quest to be thin and a fear of being fat. In general,
there are two kinds of anorexia: 1. a dangerously
low calorie intake, and 2. not only low calorie intake,
but also binging and purging behaviour. On the outside,
anorexics appear to be successful, independent, intelligent,
and overachievers. But while they think they are able
to control their desire to eat, what they don't realize
is that soon they are controlled by that desire and become
obsessed with it. Someone with anorexia no longer
sees reality clearly; this can be seen when she insists
she is fat, even when there is no fat there at all.
Bulimia nervosa is a type of eating disorder
closely linked to anorexia, however it is more common than
anorexia and it can go undetected for years because it is
hard to identify. It is often harder to pinpoint because
a bulimic is usually within a normal weight range, which
will go up and down within 5 - 10 pounds. There are
two categories of bulimia: 1. the use of vomiting, laxatives,
diuretics, or enemas following the binge; 2. the non-purging
type, which uses other inappropriate behaviors to avoid
weight gain, such as fasting or exercise. What is
bingeing and purging? Bingeing is the rapid intake
of food (usually high-calorie foods), which may last several
minutes or several hours. Binges can be either planned
or unplanned. Purging is a method to not only rid
the body of food, but to get rid of unwanted feelings such
as anxiety, anger, panic, stress. It brings relief
from an overwhelming sense of guilt and physical discomfort
after eating during the binge. Interestingly enough,
even when trying to purge the body of the food to avoid
gaining weight, most calories are still absorbed by the
body.
Bulimia is an emotionally based disease,
where food is used as a way to satisfy inner needs.
Bingeing and purging is a way of taking control by providing
temporary comfort and security, even though trying to take
control like this usually leads to feelings of being out
of control. This pattern of bingeing and purging usually
develops into a daily routine, to a point where the body
loses the ability to signal satisfaction. That means
eating no longer happens because you are hungry! Bulimics
are usually ashamed and embarrassed about this lack of control,
and this is why the cycle usually happens in secret.
A person with bulimia is often dependent and compliant,
and very concerned with gaining acceptance and approval
from others. At the same time, she is also more likely
to admit eating patterns that are not normal.
What are the causes of
eating disorders? [back
to top]
How does an eating disorder happen?
Is it because the media puts pressure on girls to look a
certain way? Is it a diet that has gotten out of control?
Actually, an eating disorder is an expression of other problems
in a person's life. There may be many reasons (that
are discussed below) that build up until one triggers the
eating disorder. At the same time, it is also important
to understand that those psychological, biological, and
cultural factors all impact an individual differently, depending
on a person's particular situation. So while any one
of the reasons that will be discussed are valid and possible,
they alone or in combination do not guarantee that someone
will develop an eating disorder. An example of this
is found in the fact that while not all diets lead to eating
disorders, 80% of all eating disorders start with a diet.
Food is often used as a way to fill emotional
need; soon all thoughts and actions revolve around food
and eating rather than with emotions and feeling.
It is used to numb the emotional pain. Also, there
is often a huge fear of being fat, and a desire to perfect
one's self through one's body. As a result, any one
of the following reasons can add to an eating disorder developing:
- A distorted self-image and a lack of
self-esteem
- A desire to be perfect and please others
- Stressful situations where you are not
able to cope or control the circumstance
- Developmental changes (i.e. puberty)
- Society’s obsession with being
slim and the huge focus placed on nutrition and physical
fitness. The media convinces us that there is a certain
way we should look in order to be worthy and acceptable
to others
- Family issues (including families concerned
about food, rigidity, overprotectiveness, and
lack of conflict resolution)
- Peer relationships: this could be related
to an absence of close friends, or the participation in
“fat talk” (sympathizing over how fat one
looks and hates one’s body), which brings each other
down
What
symptoms should I look for? [back
to top]
. . . in anorexia:
Behavioral:
- During the initial stages, it may be
difficult to distinguish from normal dieting
- Finds excuses to eat alone
- Fasting
- Exaggerated interest in recipes and cooking
for others
- After eating, one is anxious, complains
of feeling "stuffed"
- Minimizes caloric consumption and maximizes
energy output
- Vomiting, laxatives, diuretics may be
used
- May wear loose fitting clothes (to hide
weight loss)
- Poor performance in the classroom, athletics,
etc.
- Mood swings and quick temper
- Deterioration or absence of family or
social relationships
- Obsessive-compulsive behaviors (i.e.
preoccupation with thoughts of food, weight, and exercise)
- Refusal to maintain body weight over
minimal normal weight for age and height
- Introverted and withdrawn
Physical:
- Weight loss of at least 15% body weight
expected
- Similar to a prolonged period of malnutrition
and starvation
- Rapid weight loss (with no known physical
cause)
- Overly sensitive to the cold; difficulty
in regulating body temperature
- Grows fine hair (lanugo) to maintain
warmth
- Lackluster hair, skin, nails; brittle
hair and nails; thinner hair; dry scaly skin
- Declining condition of teeth and gums
(if vomiting)
- Low energy, weakened body (missing proper
nutrients)
- Skeletal appearance, sunken eyes
- Osteoporosis (as a result of calcium
loss)
- Abnormal heart function
- Absence of at least three consecutive
menstrual cycles
- Kidney complications
- Intestinal problems and constipation
(because digestion slows down)
- Muscle loss and decreased bone density
- Fainting spells
- Insomnia
- Dehydration
- Lowered blood pressure, slowed pulse
rate
- Electrolyte imbalance
- Loss of breast tissue
- Gastritis
- Delayed emptying of stomach
- Long-term: damage to vital organs, muscles
and bones, reproductive system, brain
- Increased risk of fertility problems
Psychological:
- Depression
- Lowered self-esteem
- Feeling of being unloved, unaccepted,
deficient
- Strong feeling of guilt (to eat is a
weakness)
- Intense fear of becoming obese (fear
does not diminish as weight loss progresses)
- Suicidal tendencies
- Disturbance of body image
. . . in bulimia:
Behavioral:
- Binge eating and purging through vomiting,
laxatives, diuretics, and excessive exercise
- Minimum average of two binge eating episodes
per week for at least three months
- Usually demonstrate restrained, controlled
eating behavior in public
- Social isolation
- Quick exit after eating
Physical:
- Observable weight fluctuations
- Nutritional irregularities
- Loss of concentration and fatigue
- Brittle fingernails
- Dryness and loss of hair
- Dryness of skin
- Abnormal heart function
- Kidney complications
- Muscle loss and decreased bone density
- Muscle spasms in legs and hands
- Menstrual irregularities (or cessation)
- Poor circulation
- Damage to esophagus (irritation, tear,
or rupture)
- Increased risk of fertility problems
- Vomiting can become an involuntary behavior
- Electrolyte imbalance (potassium, chlorine,
sodium) can be the most serious side effect
- Some symptoms specific to method of purging
used:
- Vomiting: sore throats, mouth
and gum ulcers, dry/cracked lips, enamel loss, tooth
decay, generalized swelling (hands, feet, face), salivary
gland irregularities, constipation, cuts or marks on
knuckles and fingertips, broken blood vessels in face,
legs, and arms
- Laxatives: abdominal cramping,
nausea, vomiting, bloating, constipation, bowel dysfunction,
colon damage
- Diuretics: dehydration, kidney
impairment
Psychological:
- Obsession with thinness
- Diminished sense of self-confidence
- Associates thinness with success, attractiveness,
happiness
- Not able to recognize own successes or
accept recognition of their success by others
- Suffer from anxiety and depression
- Feeling lack of control over eating behavior
during binges
While the focus has been on anorexia and
bulimia, a third syndrome is known as binge eating disorder.
This can be described as binge eating without the use of
purging. It is also known as compulsive overeating.
The symptoms associated with this disorder are as follows:
Behavioral:
- Loss of control over food
- Overvalue thinness
- Observable weight fluctuations
- People pleaser
Physical:
- Difficulty maintaining stable weight
- Long-term consequences related to obesity
(i.e. diabetes, hypertension, etc.)
- Outwardly appear happy and content
Psychological:
- Feeling unwell or unhappy
- Anxiety, low self-esteem, need for approval
and acceptance by others, difficulty expressing anger/frustration,
disgust, guilt
- Set unrealistic weight loss goals (with
attitude that weight gain equals personal failure)
How
do I avoid eating disorders? [back
to top]
The prevention of eating disorders begins
with becoming aware. First of all, it is important
to realize the message our culture sends us that says being
thin equals being beautiful is wrong. You yourself
can take steps to avoid an eating disorder:
- Become aware of your own eating habits
- Eat only when you are hungry (not for
emotional reasons)
- Stop eating when you are full
- Talk about your feelings with an adult
- Avoid "fat talk" with others
- Think critically about the advertisements
you see on television and the real message they are sending
- Look for help when you are feeling out
of control
- Get involved with sports that emphasize
strength
- Throw out the scale and give away clothes
that do not fit
The goal is to change your behavior to develop
healthy eating habits, as well as to change your attitude
toward food. Not only that, it is important to address
the emotions that are thought to be the underlying causes.
With this in mind, eating disorder recovery should consist
of two parts: taking care of medical problems, and dealing
with your thoughts and emotions. While safely gaining
healthy weight is important in recovery, this does not necessarily
mean you have recovered fully. You should no longer
be afraid of getting fat, or be obsessively preoccupied
with weight. The sooner you get help, the better your
chance for a full recovery. At the same time, you
need to realize that recovery is a long-term process, and
there is no quick cure for eating disorders. Treatment
may include hospitalization, medication, dental work, individual
counseling, group counseling, family counseling, nutrition
counseling, or support groups.
If you realize that you have an eating disorder
and you want to get help, find someone you trust (like a
parent, family member, teacher, pastor, coach, etc.) and
tell them. It is also important to see a doctor so
that they can determine the severity of the eating disorder,
and if you have done any serious harm to your body.
From there, the doctor can help you find someone you can
talk to who can help you work out your emotions and the
issues that have led to the eating disorder. Remember:
success comes in small steps! It will be normal to
experience feelings such as fear, shame, embarrassment,
or nervousness, but understand that these professionals
are not threatening and are familiar with situations like
your own. You are doing the right thing!
What do
I do if I think my friend may have an eating disorder? [back
to top]
If you think your friend may have an eating
disorder, there is something you can do to help her.
You need to understand that most girls will not be eager
to talk about this subject. First of all, many girls
are in denial because they do not realize that they have
crossed the line into disordered eating. A second
reason is that they could be embarrassed or feel like a
failure because they have lost control. When confronting
someone about an eating disorder, it is a good idea to keep
the following in mind:
- Educate yourself about the problem
- Find a time that is good to talk (a quiet
time)
- Use "I" statements instead
of "you" statements
- Listen to what she has to say
- Be prepared that your help may not be
taken
- Be available if she needs help in the
future.
Before taking steps to help someone who
has an eating disorder, it is very important to know your
own limitations. It is wise to refer the person to
a physician, counselor or psychologist, or a family therapist,
especially if the case is severe. Your role may be
to support them once they have decided to go for help.
That is an important role to play! And remember: you
aren't helping if you do nothing at all!
