Eating Disorders: Anorexia
Each year millions of people in the United States are affected by serious and sometimes life-threatening eating
disorders. The vast majority are adolescents and young adult women. Approximately one percent of adolescents
girls develop anorexia nervosa, a dangerous condition in which they can literally starve themselves to death.
Another two to three percent develop bulimia nervosa, a destructive pattern of excessive overeating followed by
vomiting or other " purging " behaviors to control their weight. These eating disorders also occur in men and older
women , but much less frequently. The consequences of eating disorders can be severe. For example, one in ten
anorexia nervosa leads to death from starvation, cardiac arrest, or suicide. Fortunately, increasing awareness of the
dangers of eating disorders, sparked by medicall studies and extensive media coverage, has led many poeple to
seek help. Nevertheless, some people with eating disorders refuse to admit that they have a problem and do not get
treatment. Family and friends can help recognize the problem and encourage the person to seek treatment.
Anorexia nervosa is a disorder where people intentionally starve themselves. It usually starts around the time of
puberty and involves extreme weight loss. Sometimes they must be hospitalized to prevent starvation because food
and weight become obsessions. For some, the compulsiveness shows up in strange eating rituals, some even
collect recipes and prepare gourmet feasts for family and friends. Loss of monthly menstrual periods is typical in
women with this disorder and men with this disorder usually become impotent.
People with bulmia nervosa consume large amounts of food and then rid their bodies of the excess calories by
vomiting, abusing laxatives or excersising obsessively. Some use a combination of all these forms of purging.
Many individuals with bulimia " binge and purge " in secret and maintain normal or above normal body weight,
they can often successfully hide their problem from others for years. As with anorexia, bulimia typically begins
during adolescence. The condition occurs most often in women but is also found in men. Many individuals with
bulimia, do not seek help until they reach their thirties or forties. By then, their eating behavior is deeply ingrained
and more difficult to change.
Medical complications can frequently be a result of eating disorders. Individuals with eating disorders who use
drugs to stimulate vomiting, may be in considerable danger, as this practice increases the risk of heart failure. In
patients with anorexia, starvation can damage vital organs such as the heart and brain. To protect itself, the body
shifts into " slow gear ": monthly menstrual periods stop, breathing, pulse and, blood pressure rates drop, and
thyroid function slows. Nails and hair become brittle, the skin dries, yellows, and becomes covered with soft hair
called lanugo. Excessive thirst and frequent urination may occur. Dehydration contributes to constipation, and
reduced body fat leads to lowered body temperature and inability to with stand cold. Mild anemia, swollen joints,
reduced muscles mass, and light headedness also commonly occur in anorexia. If the disorder becomes severe,
patients may lose calcium from their bones, making them brittle and prone to breakage. Scientists from the
National Institute of Mental Health ( NIMH ), have also found that patients suffer from other psychiatric illnesses.
They may suffer from anxiety, personality or substance abuse disorders, and many are at a risk for suicide.
Obsessive compulsive disorder, an illness characterized by repetitive thoughts and behaviors, can also accompany
Bulimia nervosa patients- even those of normal weight- can severly damage their bodies by frequet binge eating
and purging. In rare instances, binge eating causes the stomach to rupture, purging may result in heart failure due
to loss of vital minerlas, such a potassium. Vomiting causes other less deadly, but serios, problems. The acid in
vomit wears the outer layer of the teeth and can cause scarring on the backs of hands when fingers are pushed
down the throat to induce vomiting. Further the esophagus becomes inflamed and glands near the cheeks become
swollen. As in anorexia, bulimia may lead to irregular menstual periods and interest in sex may also diminish.
Some individuals with bulimia struggle with addictions, including abuse if drugs and alcohol, and compulsive
stealing. Like individuals with anorexia, many people with bulimia suffer from clinical depression, anxiety
obsessive compulsive disorder, and other psychiatric illnesses. These problems place them at high risk for suicidal
behavior. People who binge eat are usually overweight,so they are prone to medical problems, such as high
cholesterol, high blood pressure, and diabetes. Research, from the NIMH scientists, has shown that individuals
with binge eating disorder have high rates of co-occuring psychiatric illnesses, especially depression.
Eating disorders are most successfuly treated when diagnosed early. Unfortunalty, even when family members
confront the ill person about his or her behavior, or physicians make a diagnosis, individuals with eating disorders
may deny that they have a problem. Thus, people with anorexia may not receive medical or psychological attention
until they have already become dangerously thin and malnourished. People with bulimia are often normal weight
and are able to hide their illness from others for years. Eating disorders in males may be overlooked because
anorexia and bulimia are relatively rare in boys and men. Consequently, getting and keeping people with these
disorders into treatment can be extremely difficult.
In any case, it cannot be overemphasized how important treatment is for the people who have these disorders. The
longer eating behaviors persist, the more difficult it is to overcome the disorder and its effect on the body. If an
eating disorder is suspected, particularly if it involves weight loss, the first step is a complete physical examination
to rule out any other illnesses. Once an eating disorder is diagnosed, the clinician must determine whether the
patient is in immediate medical danger and requires hospitalization. While most patients can be treated as
outpatients, some need hospital care. Conditions warranting hospitilization include excessive and rapid weight
loss, serious metabolic disturbances, clinical depression or risk of suicide, severe binge eating and purging, or
psychosis. The complex interaction of emotional and physiological problems in eating disorders calls for a
comprehensive treatment plan, involving a variety of experts and approaches. Ideally the treatment team includes
an internist, a nutritionist, an individual psychotherapist, and a psychopharmacologist. To help those with eating
disorders deal with their illness and underlying emotional issues, some form of psychotherapy is usually needed.
Group therapy, in which people share their experiences with others, has been especailly effective for individuals
NIMH supported scientist, have examined the effectiveness of combining psychotherapy and medications. In a
recent study of bulimia, researchers have found that both intensive group therapy and antidepressants medications,
combined or alone, benefited patients. In another study of bulimia, the combined use of cognitive behavioral
therapy and antidepressant medications was most beneficial. This comibination treatment was particularly effective
in preventing relapse once medications were discontinued. For patients with binge eating disorder, cognitive
behavioral therapy and antidepressant medications may also prove to be useful. For anorexia, preliminary evidence
shows that some antidepressant medications may be effective when combined with other forms of treatment.
Fluoxetine has also been useful in treating some patients with binge eating disorder and depression.
The efforts of mental health professionals need to be combined with those of other health professionals to obtain
the best treatment. Physicians treat any medical complications, and nutritionists advise on diet and eating regimens.
The challenge of treating eating diorders is made more difficult by the metabolic changes associated with them. Just
to maintain a stable weight, individuals with anorexia may actually have to consume more calories than someone of
similar weight and age without an eating disorder. This is important, because consuming calories is exactly what
the person with anorexia wishes to avoid, yet must do to regain the weight necessary for recovery. In contrast,
some normal weight people with bulimia may gain excess weight if they consume the number of calories required
to maintain normal weight in others of similar size and age.
Treatment can save the life of someone with an eating disorder. Friends, relatives, teachers, and physicians all play
an important role in helping the ill person start with a treatment program.
Encouragemnt, caring, and persistence, as well as information about eating disorders and their dangers, may be
needed to convince the ill person to get help, stick with treatment, or try again.
Family members and friends can call local hospitals or university medical centers to find out about eating disorder
clinics and clinicians experienced in treating the illnesses, for the college students, treatment progams may be
available in school counseling centers.
Family and friends should read as mush as possible about eating disorders, so they can help the person with the
illness understand his or her problem. Many local mental health organizations and the self help groups provide free
literature on eating disorders. Some of these groups also provide treatment program referrals and information on
local self help groups. Once the person gets help, he or she will continue to needs lots of understanding and
encouragement to stay in treatment.
NIMH continues its search for new and better treatments for eating disorders. Congress has designated the 1990's
as the " Decade of the Brain, " making the prevention, diagnosis, and treatment of all brain and mental disorders a
national research priority. This research promises to yield even more hope for patients and their families by
providing a greater understanding of the causes and complexities of eating disorders.