Eating disorders are conditions that cause a person to spend most of their waking hours thinking and obsessing about food, weight, calories, and/or body image. These obsessions may cause them to binge eat, starve themselves, or binge and purge.
Fertility problems later in life
Child-birth - The average birth weight of a baby born to an active anorexic is 5.7 pounds. The average birth weight of a baby born to an active purging anorexic is 4.9 pounds. In a long term Danish follow-up study of women with anorexia, perinatal mortality was nearly six times greater and incidence of low-birth-weight babies two times greater than expected rates (Renfrew).
Ovarian failure - unable to conceive later in life
Heart irregularities (mitral valve prolapse), heart attacks, sudden death
Liver damage - liver and multiple organ failure
Intestinal problems caused by the use of laxatives
Addiction-to diet pills, laxatives, drugs (often cocaine or methamphetamine) and/or alcohol abuse
Change in voice/irreversible hoarseness
Erosion of the gums or receding gums
Low blood pressure
Lesions in the esophagus
10-15% of all Americans suffer from some type of eating disorder. These illnesses can last anywhere from 5-15 years or more. The longer the duration of the illness, the greater chance of death or severe, irreversible medical consequences. Eating disorders are progressive and can result in serious mental and physical illness and/or death. (www.rockhillcommunications.com, 2000).
Individuals with eating disorders often become socially withdrawn and may chose to avoid any contact with friends and loved ones. They often feel inadequate and guilty because of their illness. They feel unworthy of love and will often become involved in destructive relationships.
One with an eating disorder will generally deny feelings until they hit a "rock bottom" so to speak. They have such a need to appear "perfect," that it is not until this crisis that they even begin to admit that their behavior may be a problem they cannot control.
There are several forms of "eating disorders," of course they all share the common link of having to do with the way one eats or doesn't eat. The truth of the matter is that it's not about the food at all. It's an attempt to use food and weight to deal with emotional problems.
The link between eating disorders and substance abuse
- 50% of individuals with eating disorders abuse alcohol and/or illicit drugs, compared to the 9% in the general population who use (CASA, 2004).
- Up to 35 % of individuals who use drugs/alcohol suffer from some type of eating disorder (CASA, 2004).
Before 1983 little was known about Anorexia Nervosa. Although anorexia has been documented throughout history the media was virtually unaware until the death of Karen Carpenter in 1983. Her death brought eating disorder awareness to our attention for the first time.
Anorexia nervosa is characterized by the refusal to maintain the minimally accepted body weight, the intense fear of gaining weight, the obsessions of thinness, perfection, and often counting calories. Many times the person with anorexia will believe they are "fat" even though they are below "normal" body weight. However, that is not always the case. Many individuals with anorexia realize they are thin, some even recognize that they are too thin and don't necessarily like it, yet these individuals are so intensely afraid to gain weight that their weight continues to plummet to an even more dangerously low weight.
As weight loss continues the cognitive functioning of the individual becomes impaired and they are no longer able to see things as clearly as they did before. Thoughts and beliefs become distorted. Their body image as well as the image of others becomes skewed. Their choices become compromised and their emotions harder to handle which increases the desire for the individual to engage in the disorder.
Anorexia nervosa is most commonly seen in teenage girls; however it also occurs in pre-teen girls, teenage boys, and adult women and men. People with anorexia are 15% below the "normal" weight for their size based on height. These individuals restrict, meaning they refrain from eating as long as possible. Many individuals simply restrict food altogether.
Much of the time they will play with their food, push it around the plate, feed it to the dog under the table, or chew food and spit it out in their napkin, amongst numerous other techniques they have discovered. Sometimes individuals with anorexia will restrict and then purge what little food they do take in. The idea is that the purging will compensate for the food they ate. However, this is not only ineffective but also a "myth." There are many ways of purging; sometimes one will vomit after they eat, some will consume laxatives, diuretics (water pills) and some will workout excessively up to 6 or 8 hours a day.
Health Consequences of Anorexia Nervosa
Individuals struggling with anorexia have an absence of menstruation, a decrease in strength and muscle atrophy, loss of fatty tissue, low blood pressure, abnormally slow heart rate, a reduction in bone density, severe dehydration which can result in kidney failure, fainting, fatigue and overall weakness. Their skin can appear yellow, blotchy, and/or scaly. Facial hair grows in an attempt to provide "heat" for the starving body (lanugo).
Depression is very common in all eating disorders, but especially in anorexia. It is unclear as to whether or not the depression is one of the causes of anorexia or if it is a direct result of low body weight.
Anorexia nervosa is caused by many different elements in one's life and therefore it is impossible for researchers to identify a specific "reason" one develops anorexia and others do not. This is often frustrating not only for the individual with anorexia but for their loved ones as well. It is because of the many dynamics that make up the disorder that treatment can rarely be "brief." Unfortunately many individuals with anorexia refuse to believe that they are indeed in danger. Many simply believe that they are successful at their "diet" and simply want to be left alone. Many are in denial for a long time which makes treatment that much harder and lowers the survival rate.
Bulimia nervosa is the eating disorder which is defined by food binges where one consumes large amounts of food or recurrent episodes of significant overeating. The eating behavior is then followed by remorse, and a sense of loss of control. The individual then uses various methods of purging or engages in periods of fasting to avoid weight gain. The main difference between anorexia and bulimia is that individuals with bulimia tend to be of a more "normal" weight or even a little heavier. Their weight often fluctuates but seldom dips as low as one with anorexia.
Another difference is that the individual with bulimia usually knows and acknowledges that something is "wrong." They often feel shameful, remorseful, and disgusted with their behavior, especially when they use vomiting and /or laxatives as means of purging. Individuals with bulimia often feel "out of control" and want help of some kind, where people with anorexia often believe they are "fine" and "in control."
There are two subtypes of bulimia; the Binge-Purge Type describes individuals who regularly compensate for the binge eating with self-induced vomiting, laxative abuse, diuretics, or enemas and the Non-Purging Type who compensates for the binge eating through dietary fasting or excessive exercise.
Health consequences of Bulimia Nervosa
Probably the most dangerous complication of Bulimia is the electrolyte imbalance that can lead to irregular heartbeats and possible heart failure or sudden death. This imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging. Gastric rupture can occur during periods of binging as well as peptic ulcers and even pancreatitis. When frequent vomiting occurs, inflammation and possible rupture of the esophagus is possible which can result in death. Tooth decay, staining of teeth from stomach acids released during vomiting, and gum diseases are often found in individuals with Bulimia. For those who use laxatives and/or diuretics, chronic irregular bowel movements and constipation occur resulting in one's physical dependency on laxatives.
The recovery rate for individuals with bulimia is higher than those with anorexia simply because these individuals recognize that their behavior is "abnormal." However the danger of bulimia is just as real anorexia.
Other eating disorders are commonly referred to as compulsive overeating or now called binge eating, night eating syndrome, or eating disorder NOS (not otherwise specified). The diagnosis of Eating disorder NOS is used when the individual does not meet all necessary criteria for one of the other disorders. Compulsive overeating or binge eating refers to individuals who continually eat large amounts of food in order to "numb out" or to hide feelings they may feel are inappropriate to have. These individuals are often clinically obese, depressed, embarrassed and commonly have medical problems as a result of obesity.
The health risks associated with binge eating is similar to those with clinical obesity.
Night eating syndrome is perhaps the newest eating disorder. This is where an individual wakes in the middle of the night, gets out of bed and eats/binges. They are often completely unaware of what they have done during the night until they awake to a mess of food in the kitchen. Some will bring food to bed with them and wake up with crumbs as the only evidence of their binge. Sometimes these individuals will remember their binges and sometimes they will not. These individuals feel a huge sense of failure and loss of control which often leads to the secrecy of their disorder and the lack of seeking treatment.
MYTH: "Eating disorders are "phase of life" problems"
Individuals will simply not "get over it" or "grow out of it." They are not a "cry for help" and individuals do not normally use their eating disorder in an attempt to simply "get attention." Eating Disorders are serious and complex problems arising from a combination of physical, emotional, social, and familial issues. All of these issues have to be addressed for recovery to be successful.
MYTH: "Individuals with eating disorders are "crazy"
In fact, individuals suffering from an eating disorder are often the most mentally healthy individual in the family system. They simply are the "identified patient" that the family focuses on as the problem in order to prevent dealing with the underlying problems of the family unit.
MYTH: "Eating disorders are just an upper/middle class white woman's problem that is self-imposed and therefore can be "fixed."
Eating disorders are complex and chronic illnesses that are often misunderstood and misdiagnosed in our society. The fact is that all socioeconomic and ethnic groups are at risk. In fact one of the most at risk populations is Japanese girls. And in countries such as Argentina the eating disorder rates are 3 times higher than those in the US, based on population.
MYTH: "Eating disorders only effect teens and adults"
People often think that eating disorders do not happen to little girls. WRONG! Children ages 8 to 12 are being admitted to treatment facilities for eating disorders in growing numbers. The problem we now face, many facilities are not equipped to treat these young girls. The costs of treating young kids are another huge expense currently not covered by most insurance companies.
MYTH: "Eating disorders are just a "woman's problem."
The growing rate of males seeking treatment for eating disorders is proof of that. Males are preoccupied with shape and weight and can not only suffer from eating disorders but are also at risk for steroid use. Also males play a huge role in prevention by commenting on girls' looks, whether positive or negative. We know that women's bodies are the focus of objectification and this contributes directly to one's obsession with their appearance and shame about their body.
It is possible to fully recover from an eating disorder! Recovery is an ongoing process where one learns to be more aware of their surroundings, their feelings, and the feelings of others. They work at being conscious of their eating habits, bodily sensations, spirituality, relationships, and how to ask for what they need. Individuals who recover from their eating disorder are often some of the most mentally and physically "healthy" individuals we see in our society. They are well-rounded and are able to achieve a sense of balance in their lives that lead to a more accepting and peaceful spirit.
Perhaps the biggest myth of all is that others can "understand" the intense fear, loneliness, and anguish that the eating disorder brings. The fact is that we all feel our fear, loneliness, and misery differently, and for those who have never experienced an eating disorder in their life it is impossible to fully grasp the pain that accompanies these disorders. One of the most common statements made by eating disordered individuals are "You don't understand… no one understands…" Often we try to tell them we do understand… No we don't! And that's OK. The mere fact that we really want to understand and wish we could understand is more comforting to the individual than claiming that we "know" how they feel.
Here in Orange County there is the myth that eating disorders are a "fad." The idea is that girls simply engage in these acts together as a means of dieting. Yes, sadly some times individuals get started in their eating disorder by "dieting" with their friends, but the ones who will develop an actual eating disorder are not doing it to fit in or as a dietary tool. The mental anguish and physical pain that come along with the disorder simply are not worth the perceived "perks."
Other Consequences of Eating Disorders
Eating disorders are serious medical conditions that can affect all organs in the body and Anorexia is the 3rd most common chronic illness among adolescents (Public Health Service's Office in Women's Health, 2000). Both anorexia and bulimia can have serious and irreversible medical complications. A young woman with anorexia is 12 times more likely to die than other women her age without anorexia (HEDC). Eating disorders have the highest mortality rate than any other mental illness, including all drug/alcohol disorders and depression.
An estimated 480,000 people die every year from complications related to eating disorders (Renfrew). However we know that these statistics are underreported because eating disorder and related deaths are not tracked by any US government agency, where as other mental and medical illnesses are.
Dual diagnosis- often one with an eating disorder has other diagnosable disorders. Some include: depression, anxiety, panic disorders, obsessive-compulsive disorders, post traumatic stress disorder (PTSD), substance abuse, and others. Personality disorders are often seen as well; some examples are Bi-polar disorder, obsessive-compulsive personality disorder, and borderline personality disorder to name a few.
Other co-existing (Dual-diagnosis) disorders include:
High risk of Suicide
Dependant personality disorder
Obsessive compulsive disorder
Post-traumatic stress disorder (PTSD)
Immediate and long-term consequences
Risk for illness- due to a compromised immune system
Voice problems - irreversible
Muscle cramps - due to low potassium and sodium
Dental consequences (long-term effects of enamel)
Stomach/digestion problems - heart-burn, slowed digestion
Chronic irregular bowel movements and constipation - may be irreversible
Ulcers and pancreatitis
Chest pain and abnormal heart rate - potassium loss, impaired electrolyte function
Serious long-term heart problems that may lead to heart failure or sudden death
Childhood and adolescent years are lost. For every year an individual engages in their eating disorder they lose that year of personal/psycho-social development. For instance if a girl starts her diet that results in the diagnosis of anorexia at age 13, her mental development is slowed until she is free of her eating disorder. The disorder allows her to numb out and disengage from life, therefore keeping her from fully developing mentally. As a result she is unable to learn important life skills that most others do at a similar age.
Individuals also suffer the loss of friendships and other relationships because of their inability to fully be themselves. They remain emotionally distant from others and often chose to isolate themselves from other family members and friends. As the isolation continues, the depression worsens.
Treatment alone is extremely expensive, even if insurance is involved. Many individuals with eating disorders spend their money on food for their binges. This may be hundreds of dollars per week .
Another financial concern is the use of illegal drugs to shut down any hunger or obsessions they may have. Cocaine and methamphetamine are well known for their ability to shut down hunger signals and speed up metabolism. Many eating disordered individuals use both these drugs and others. The use of these drugs bring an even bigger concern for safety. Both drugs carry with them a large risk for overdose which leads to heart attacks, emergency room trips, or jail at the very least.
Eating disordered individuals may require several inpatient hospital treatment programs in their life time. It is not uncommon to see individuals in at least three different treatment centers throughout their battle with the eating disorder. Many of these treatment facilities are $50,000.00 each visit. Therefore it is fairly common to see parents finance the money needed for treatment and re-finance their homes just to provide a chance of recovery with a new treatment facility.
Career goal interuptions
Eating disorders get in the way of every aspect of one's life, including school, social, and employment arenas. The eating disorder controls one's life and other interests take a back seat to the demanding illness. Eating disorders require much emotional energy, mental focus and obsession. Much of the day is spent agonizing and obsessing about their disorder that anything else may seem impossible to accomplish. These individuals feel overwhelmed, anxious, and scared. These feelings lead right back to the disordered patterns, sometimes spending 6 to 8 hours every day engaging in their eating disorder behavior alone.
How do you know if you or someone you love has an eating disorder?
Take the eating disorder screening inventory (coming soon)
Symptoms and signs
Constant dieting or reference to dieting
Exaggerated interest in food or counting calories
Cooking and/or baking for loved ones
Noticeable weight loss
Excessive exercise and extreme irritability if one cannot exercise
Chemical abuse (diet pills, laxatives, diuretics, amphetamines)
Excessive use of caffeinated drinks
Lack of interest in school and social events
Excessive tardiness and/or absence
Unable to commit to social functions or family gatherings
What to do next?
First and most important is to seek help with a physician who is knowledgeable about eating disorders. Ask to have a full blood panel to rule out any kind of immediately needed medical intervention.
Next, find a therapist who is knowledgeable in the treatment of eating disorders. Don't allow their titles (M.S, M.A, PhD, MSW, MFT, etc.) to influence your decision; check them out personally; ask questions, and remember your judgment should not be based solely on their title or the license they hold. The therapist you find the eating disordered individual is most comfortable speaking with is the therapist you need. But most important, you need to be "comfortable" with your therapist. The therapeutic relationship itself is the most important part of treatment. If one does not have a connection with their therapist, trust cannot fully develop, and recovery will not occur.
What to look for in a treatment provider:
Any treatment provider in the state of California, whether it be an individual therapist, or an inpatient program, must be licensed in the state of California. If they are not, then you need to know that the State of California Board of Behavioral Sciences is not looking over these individuals. As long as the treatment provider is "licensed" by the state of California, then you as a consumer are ensured that the therapist you see meets the rigid and unique criteria that the California State Licensing Board demands. Other state licensures are not necessarily recognized in our State because of California's increased requirements for mental health providers. If you have any concerns about licensing information you can contact the BBS (Board of Behavioral Sciences) at: 400 R Street, Suite 3150, Sacramento, CA 95814 (916) 445 - 4933.