Have you, or anyone you’ve known, ever gone through an eating disorder? Many people struggle with eating disorders on a daily basis. Anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified are disorders in which starvation and food control are important factors. Eating disorders are both physical and emotional. No one person wants to have an eating disorder, the disorder chooses them. They have no control over their perspective of their bodies, weight, and food. Many people think that eating disorders have nothing to do with the mind and those who suffer are just looking for attention.
Eating disorders are intense psychological disorders affecting individuals worldwide. The term anorexia nervosa means “lack of hunger” because it appears that the person is rarely hungry. This is a misnomer because even when someone starves themselves, they still have an average appetite. People with anorexia nervosa have an intense fear of becoming fat (Cassell and Gleaver, 2006a). These people will go to intense extremes to stay thin and avoid food. The cause is often psychological. People with anorexia have abnormal cognitions and morbid preoccupations with their weight and size.
Many of these people display perfectionistic tendencies and dislike not being absolutely perfect (Cassell and Larocca, 1994a) Anorexics have a wide array of emotions when it comes to their eating disorder. Anorexics often feel locked within themselves and the outside world is locked out to them (Lask). They will consider themselves fat even after they are dangerously under weight (Vollstadt). This can make them depressed, stressed, and overwhelmed (Cassell and Larocca, 1994a). Several wish to stay child-like and fear growing up (Cassell Felix Anorexia).
According to Lucy Joswick, an individual who went through an eating disorder herself, she often felt a strong sense of control because food was something she could control in her life. An anorexic is very determined with his or her weight loss. They will avoid food whenever possible. If in a situation when eating is required, the person may undergo self-induced vomiting or laxative abuse to relieve themselves of the food. They will often limit their calorie intake to 600-800 calories per day. The fear of gaining any weight will frequently cause an anorexic to take up excessive exercise programs (Cassell Anorexia)(Lask)(Vollstadt).
Weight loss is also pathological. Anorexics are habitually preoccupied with food and with dieting. Some feel that they should weigh nothing at all. The patients do not see themselves as abnormal, but believe what they are doing is right and justified (Keel). Anorexia nervosa has many warning signs, but not all who suffer with it display the symptoms. Extreme weight loss is the most common effect of anorexia. Patients will often talk about being “fat” and “obese” when they are actually thin. This talk of their distorted body image and fear of becoming fat is often one of the easiest signs in recognizing an eating disorder (Vollstadt).
Those with eating disorders are often preoccupied with food, calories, and nutrition. Some may become so preoccupied that they will weigh each piece of food eaten to ensure the closest calorie count possible (Odle). Since most times anorexics do not eat or drink, they often become dehydrated and may be admitted to the hospital. This is usually the first time people become aware of an anorexic’s condition. Some individuals show signs of being socially isolated, preferring to exercise and eat alone. Someone with anorexia may compulsively exercise or binge and purge to ensure further weight loss (Vollstadt).
Since anorexics no longer get the required daily nutrition needed for their bodies, they may fail to grow in height or develop during adolescence. Since many will lack the body fat to keep themselves warm, a fine hair called lanugo may begin to cover the body to help keep the individual warm. They will often have difficulty with attention, memory, concentration, and problem solving, and may display odd behavior. They may also act tired and irritable (Keel). Since anorexics are very deceptive; it may be hard to see these physical signs (Cassell and Gleaver, 2006a).
During treatment, some will resort to all kinds of deceptions to allow doctors to believe that they are gaining weight. Before being weighed, some will drink enormous amounts of water to help them gain a few pounds. Some have also been known to recalibrate scales to make it appear as if they have gained weight. A few have even inserted weights into the rectum and vagina to add more weight to their bodies during weigh-ins (Cassell and Larocca, 1994a). Anorexics will often display these warning signs, but not all of them. Many anorexics are in denial of their condition.
They will deny being hungry to anyone who asks or even to themselves. They deny thinness and their overall appearance (Cassell and Gleaver, 2006a). Since the lack of food takes such a large toll on the body, there are many physical dangers associated with anorexia. An irregular heartbeat is common among most anorexics. All girls with anorexia have a lack of menstrual periods; if an individual continues to have a period, it is classified as an eating disorder not otherwise specified. If an anorexic recovers, she may be infertile because of the damage already caused to her ovaries and uterus.
Kidney stones are also very common among the anorexic population. The body will try to defend the vital organs when it is not receiving adequate nutrition. Muscle atrophy may occur even though most anorexics appear to have a vigorous exercise routine. This is also due to the lack of nutrients. The body will take nutrients from wherever it can, including from muscles and bones. Bones may undergo calcium loss, causing them to shrink, become brittle and easily broken, leading to osteoporosis (Keel). Anorexics may have an electrolyte imbalance after not eating anything.
Electrolyte imbalances may cause: muscle weakness, abdominal bloating, nervous irritability, apathy, fatigue, drowsiness, dizziness, mental confusion, irregular heartbeat, and kidney failure (Cassell and Gleaver, 2006a). When an anorexic decides to abuse laxatives over a long period of time, bowel irritation and constipation is common. The body will become dependent on the laxatives; so when someone stops taking them, it becomes difficult for the body to function correctly (Vollstadt). If a person remains anorexic for any years, his or her metabolism will slow down in the body’s attempt to hold onto any food and nutrients the body attains (Eating 2009). After the body has gone through its fat reserves and takes nutrients from the bones and muscles, the body will slow down the breathing rate, pulse, and blood pressure. A loss of brain tissue and an inability to control body temperature may occur. The body’s state is in a serious decline that will often lead to death (Vollstadt). Anorexia nervosa has the highest death rates of all psychiatric disorders. Five to ten million Americans are affected by anorexia each year (Smolin).
Anorexia affects mostly young women in their teens and twenties, the highest risk group being those in the age group of 12 to 18 years old. About 90% to 95% of patients are female. Although it is not as prevalent, anorexia does occur in males. About one million males suffer from anorexia. Males do not always desire to become thin, but desire well defined muscles. In 85% of all patients, onset is between the ages of 13 and 20 years old. Usually, the onset of anorexia in males is earlier than females, although psychologists are not exactly sure why.
In America, on average 1 out of every 100 females is struggling with anorexia. One out of every five of those going through treatment die. Another 50% of patients recover within two to five years, the other 50% relapse during treatment. On average, 38% are rehospitalized within two years and 50% of those who recover have problems with phobias, depression and social adjustment (Cassell and Larocca, 1994a). About 3% of all cases of anorexia occur before puberty About 5% to 10% of all cases occur in males (Cassell and Gleaver, 2006f). Thousands of these individuals die each year from complications (Smolin).
Currently the mortality rate is 6% to 18% (Cassell and Larocca, 1994a). Anorexia is a problem even in small children. Children may become anorexic as early as four years of age. These children become emaciated more quickly because they do not have an equivalent build-up of fat as older people do. These children will often become clingy to close family and friends. They can often have difficulty with peer relations and are psychologically immature. They may suffer from a type of depression and do not have the ability to translate their feeling into words (Cassell and Gleaver, 2006b).
Many factors play a role in the causes of anorexia nervosa, but they often relate to environmental and social influences. (Eating McGraw). Cultural influences seem to play a large role for this condition. Many individuals from the upper or middle class seem to be affected the most by anorexia; few cases of people in lower classes have anorexia. The amount of people affected by eating disorders has risen in industrialized nations in the past twenty years, more than ever before. The diet industry has a large role within our culture. Over 90% of customers on a diet are women.
The diet industry is a multi-billion dollar industry gaining more customers yearly (Cassell and Gleaver, 2006d). Athletes are also at a higher risk for developing eating disorders. These individuals feel a competitive need to be the best, even if that means the thinnest. People in gymnastics, figure skating, and ballet are the ones who usually feel the most pressure towards the standards of the ideal body within their sport (Smolin). Many anorexics may have developed anorexia as a result of a negative response to something occurring in their lives, whether it be psychological, environmental, or physiological.
Most occur due to stressful life situations such as: family conflicts, a family move, change of schools, a relationship breakup, serious illness, or teasing by classmates (Cassell and Larocca, 1994a). The media also plays a strong role on our society and the standards of how one should appear. The television, radio, magazines, and advertisements all send messages to people, telling them how they should look. They often give advice on how to lose weight quickly, exercise more and eat less. All of these messages tell girls “thin is in” and that by following this example, they will become more popular, sexier, attractive, and desirable.
They also tell people that by following this example, they will be more like celebrities. Many people idolize the celebrities of today. They are apt to follow their favorite celebrities, even if this means that they too will go through an eating disorder. Several celebrities, such as: Jane Fonda, Tracey Gold, Sally Field, Paula Abdul, and Princess Diana all suffered publicly with eating disorders (Smolin). Karen Carpenter is one of the most famous celebrities to endure anorexia. Her struggles began at the age of 24. She hid her anorexia for years, but decided to get treatment after nine years with anorexia.
One year later, at the age of 32, Carpenter died on February 4, 1983. The cause of death was heart failure due to an electrolyte imbalance. Carpenter’s death was the first to bring awareness of eating disorders to such a large audience (Tiemeyer 2008a). There are several different biological factors influencing eating disorders. Eating disorders may occur because of a problem within the hypothalamus. The hypothalamus controls behaviors such as: eating, sleeping, controlling body temperature, emotions, movement, and hormone secretion. A person with an eating disorder may have a chemical imbalance in their hypothalamus.
Serotonin levels within some patients are too high, suppressing their appetite so that they don’t feel hungry. In some cases, people have normal levels of serotonin, but do not have enough serotonin neurotransmitters to receive the signal of hunger (Halmi). Since eating disorders have no common cause, there is also no common treatment (Cassell and Larocca, 1994a). Treatments may include: seeing a medical professional, being educated on eating disorders, individual therapy, family therapy, nutritional counseling, and medication. In some cases, professionals may suggest a group therapy among other anorexics.
When hospitalization occurs, anorexics may be force-fed in order to bring them to a stable condition (Halmi). When undergoing treatment, males have a more difficult time and do not respond to treatment as well as their female counterparts (Cassell and Gleaver, 2006f). Since treatment takes many years and relapses occur often, the cost for therapy is often higher than those for schizophrenia (Cassell and Gleaver, 2006c). Anorexia takes its toll physically and mentally on an individual. Anorexics do not choose to have their disorders, the disorder chooses them.
These individuals struggle for the rest of their lives with an eating disorder. They may no longer eat abnormally, but their health may remain damaged for the rest of their lives. Anorexia nervosa changes all aspects of an individual’s life. The term bulimia nervosa means “ox hunger” because of the intense amounts of food eaten by an individual (Graves). Unlike anorexia, an individual with bulimia does not fear becoming fat, but fears becoming obese (Cassell and Larocca, 1994c). People with bulimia often have binges and purges or food restriction to help them control their food.
Individuals with bulimia experience a wide variety of emotions. People with bulimia often feel as if they have a lack of control, and the only way they can control their lives is through controlling their food intake. They will often shut off their emotions to others in fear that they will get hurt by people’s opinions. When people try to help, they will frequently become hostile towards them. The reason is not that they don’t want help, but that they fear other people’s judgment towards them. They will become suspicious of people who show interest or even concern toward them for this reason (Graves).
Bulimics often feel distressed and humiliated by their actions and judge themselves severely. Helplessness and dissatisfactions with their bodies are common emotions felt among bulimics. They repeatedly self-loathe themselves and will become tense and oversensitive. Since these individuals are upset by their actions, and have developed attachments with other individuals, they are more willing to accept help than anorexics are. Most bulimics appear outgoing and have developed attachments with other individuals. Bulimia is sometimes a symptom of a deeper issue: depression.
Since some bulimics have low self-esteem and don’t believe that they deserve to be happy or get help, there is a high risk of suicide (Cassell and Larocca, 1994c). During a period of binge eating, bulimics consume an immense amount of food. Binges usually occur in a short amount of time, averaging 60 to 75 minutes. The average caloric intake in that time is 3,400 calories. The average person usually consumes 2,500 calories in a day. In comparison, a person with bulimia may consume 5,000 to 20,000 calories in eight hours. (20,000 calories is equivalent to approximately 210 brownies. An individual who is on a binge will not stop eating when it becomes uncomfortable, but will eat until he or she has reached his or her physical limit. There are four main triggers that will cause an individual to binge: hunger, loneliness, anger, and fatigue. Habitually, bulimics will turn to food when they are stressed, consuming more than the average person would eat during a large meal. When binging, bulimics will eat foods high in carbohydrates and sugar. Only in rare cases do bulimics prepare a meal to binge on. Most foods eaten during a binge are pre-packaged and easily available (Cassell and Larocca, 1994b).
After binging, a bulimic will usually purge. One way to purge is to vomit. Most bulimics forcibly vomit to remove the contents of food from their stomachs. When bulimics know that they plan on vomiting after binging, they will usually eat “marker” foods during a binging episode. These foods are meant to be easily recognized after vomiting, so they know what contents they have regurgitated. They may also drink water between vomiting until the vomit appears “clean. ” Bulimics will hide vomiting by brushing their teeth often and using breath mints and sprays (Cassell and Larocca, 1994b). Bulimics may also abuse diuretics or laxatives.
They will often take 50 to 100 tablets at once. The abuse of laxatives or diuretics may cause damage to the digestive system (Odle). Fasting is another way bulimics will control their food intake. Sometimes bulimics will eat a large meal and then not eat for several days. Bulimia has several important warning signs. Bulimics will have frequent binges and purges, sometimes eating uncontrollably. Some will undergo excessive exercise after a binge or abuse laxatives and diuretics (Vollstadt). One of the most noticeable qualities of bulimics would be the fact that they use the bathroom often after meals (Odle).
Bulimics are also often preoccupied with weight, but will talk about it differently than anorexics, since their fear of weight and food is not as dramatic. In many cases, bulimics are in a depressed state and may have mood swings and emotional distress. Since bulimics will vomit often, they will usually have dental problems such as irritated gums, cavities, and rotting (Vollstadt). The acid from vomiting may also cause irritated, swollen cheeks and glands. He or she may also have frequent heartburn, bloating, and hair loss from the act of vomiting.
The lack of nutrition will also cause dark circles that form around the eyes (Cassell and Larocca, 1994c). Since bulimics have such a distorted image of food, they will avoid eating meals with others, skip meals, and diet when not binging (Graves). They may have excessive daily exercise routines to help make them feel proactive about their weight loss, and forget that they control their food so intensely (Keel). During a binge, bulimics may eat odd foods such as banana peels, orange peels, coffee grounds and condiments once they run out of normal food to eat. Bulimics may also find themselves shoplifting food when on a binge.
Because they feel guilty, they may also abuse alcohol, drugs, or credit cards to make themselves feel better, helping them forget about the emotional pain that they are going through. Bulimics may feel ashamed of their actions and may injure their fingers to prevent themselves from inducing vomiting (Graves). The effects of bulimia take a large toll on the body. There are many physical dangers associated with bulimia. The stomach acid will eat through the tooth enamel causing cavities, rotting, receded gum lines, and decay. The acid may also eat through the lining of the esophagus, causing the esophagus to tear.
The acid will also cause the parotid glands to swell (Keel). The lack of nutrients remaining in the body could also cause an electrolyte imbalance. The decreased level of nutrients may also cause: fatigue, seizures, muscle cramps, decreased bone density, bursting blood vessels in the eyes or cheeks, headaches, rashes, and irregular menstrual cycles (Eating American). Hypokalemia may also occur when potassium levels are abnormally low within the blood. Hypokalemia requires immediate medical attention and could cause death by heart failure. In very rare cases, bulimia has caused death due to gastric rupture.
Bulimics will eat so much that their stomach will split open, causing them to bleed to death internally. Not all of these physical dangers occur in all patients, but many will experience a few of them (Keel). Cases of bulimia nervosa will usually begin in adolescence or early adulthood. Bulimics have the ability to control their behavior when busy, but tend to have a difficult time when not. Bulimia is harder to detect than anorexia because usually no obvious physical evidence is seen, and may go unnoticed for many years. Most people with bulimia are considered overachievers who have a hard time handling the stress of gaining a “perfect ody” (Cassell and Larocca, 1994c). In 1995, middle-class white girls defined perfection as 5’7” and 110 pounds (Brumberg). Since bulimics are dissatisfied with their bodies, they have a strong urge to overeat to handle the stress. Bulimics usually know that their eating patterns are not normal and know that the effects of their disorder may be hazardous to their health. Approximately eight to twelve million Americans are affected by bulimia, making bulimia more common than anorexia (Smolin). Paula Abdul is one famous celebrity who has struggles with bulimia.
Abdul considers herself a perfectionist, a common trait among bulimics. Her struggles first began as a teenager. Abdul felt ashamed of her body because she felt that it should have been like the tall and thin bodies of the girls she competed against in dance auditions. While at a dance camp at the age of 15, other girls encouraged the act of purging food. After that, Abdul was bulimic. While in her twenties, she began attending Overeaters Anonymous three times a week and entered an Oklahoma psychiatric clinic in 1994. Abdul has made great progress towards recovery but on occasion still binges and purges (Tiemeyer, 2008b).
There is no known specific cause for bulimia. Bulimia usually occurs in middle or upper class homes. Bulimia is most prevalent in western cultures. Society’s standards of a “well rounded” individual will often scare perfectionists who will sense a lack of control. Since the media often displays a dislike towards people of average size, bulimics may feel dissatisfied with their bodies. They often resort to their actions, in hope that they will be perceived in a more positive light (Cassell and Gleaver, 2006d). Since the causes for bulimia are different, there is not a specific treatment for the disorder.
When undergoing treatment, bulimics will become frustrated when there are no immediate results, causing them to binge eat more frequently. Since many are overachievers or perfectionists, psychologists may assign them “unfinished tasks,” like making only half of the bed or make them stop writing in the middle of a sentence. Since treatment is so involved and a bulimic may relapse several times, the cost is usually higher than those for obsessive-compulsive disorder (Cassell and Larocca, 1994c). People who have bulimia may struggle to overcome the disorder for many years.
Since bulimics have such low self-esteem, they may feel like they are failing, even if they are improving. They will often find themselves in reoccurring patterns for years, until they are able to overcome the destructive cycle. Once bulimics are able to eat normally again, they will still often have health problems and low self-esteem. Bulimia takes a long time to manage, but can be controlled through therapy, medications, and support. Anorexia nervosa and bulimia nervosa are not the only types of eating disorders. Eating disorders not otherwise specified is a classification of a variety of different eating disorders.
These disorders are not as prevalent as anorexia or bulimia, but still impact many people’s lives (Cassell and Larocca, 2006e). Food avoidance emotional disorder and food refusal disorder are both types of eating disorders. An individual will avoid food and undergo weight loss. The occurrences are episodic and sporadic, they will eat only when they feel the need to. The periods of eating and not eating are usually situational and emotional, depending on the events of that particular day. Individuals may have unstable moods, but do not find themselves fat and do not avoid food to lose weight (Lask).
Pervasive Refusal Syndrome is a disorder that is not well known or understood. The person with pervasive refusal syndrome refuses to eat, drink, walk, or talk for no known reason. These individuals are determined to defy any efforts of help by people. Researchers do not understand the reasoning for this disorder (Lask). An individual with restrictive eating disorder will eat only a small amount of food. The nutritional content is usually normal because they do not remove foods from their diet as anorexics do. These individuals do not regard themselves as fat and do not feel as if they need to lose weight.
However, their height and weight tend to be low (Lask). On the other hand, selective eating is an eating disorder in which an individual selects a narrow range of foods to eat. These individuals are usually unwilling to try new foods, sticking only to the foods they have selected. Functional dyspahgia and other phobic conditions is an eating disorder where the person will avoid food due to fear. These people are not preoccupied with their weight. People with this disorder often fear swallowing, choking, or vomiting. They will avoid food so that they will not have to worry about these fears (Lask).
People with eating disorders often suffer for a long period of time. Their condition may remain a secret to others for many years before someone realizes it, if anyone does at all. These individuals go through such immense emotional pain, and many will die because they were not able to overcome their personal obstacles. Anorexia, bulimia, and eating disorders not otherwise specified all are composed of their own physical and mental challenges, but with help, many people would be able to make a full recovery. Those who suffer with an eating disorder often struggle physically and psychologically for many years.
