Two of the most serious eating disorders are anorexia nervosa, a complex disease characterized by a distorted body image and self starvation, and bulimia, which involves eating huge quantities of food followed by purging, usually through self induced vomiting and/or laxative abuse. More than 90 percent of those with either of these conditions are adolescent girls or young women; boys are affected only occasionally. Some persons have features of both disorders. Anorexia nervosa typically begins during early adolescence when a young girl becomes convinced that her maturing body is fat. Anorectics tend to be high achievers and are often described as obedient, ideal daughters. Some psychiatrists theorize that their eating behavior represents one aspect of life they feel they can control. A person with anorexia chronically under eats, becoming thinner and thinner and, in extreme cases, literally starving to death, while remaining firmly convinced that she is over weight. Many anorectics expend a great deal of time and energy in preparing food, which they serve to others while eating only tiny amounts themselves. In addition, some of them have ritualistic eating habits, such as cutting food up into tiny pieces or arranging it very precisely on the plate. The bulimic goes on periodic food binges, gorging on a large quantity of food in a short period of time. These binges are followed by purges, in which the individual forces vomiting and/or uses drugs to stimulate vomiting and bowel movements. Some bulimics also abuse diuretics, drugs that increase excretion of body fluids; others abuse amphetamines to prevent weight gain. Bulimics and anorectics are secretive about their eating habits and typically deny that they have a problem. They tend to be obsessive about exercising. Many have low self esteem, and some bulimics also exhibit other addictive behavior, such as alcohol abuse and compulsive shoplifting.
What causes these eating disorders is unknown, but some experts blame problematic family relationships. However, research suggests that eating disorders stem in part from brain chemical and hormonal imbalances and can be treated by eating disorder programs. Anorexia and bulimia are potentially fatal diseases. Anorectics can literally starve themselves to death, while bulimics have a high suicide rate. Metabolic and other changes brought about by their erratic eating behavior increases their risk of heart disease.
Treatment of an eating disorder requires both psychological and medical care. Some form of psychotherapy is necessary, as well as medications if the person is severely depressed. Anorectics often require hospitalization to treat malnutrition and other medical complications of starvation. Even then, calorie intake must be monitored closely to be sure the patient is eating, rather than hiding or disposing of food. (Anorectics have many strategies for misleading others into thinking they have eaten when they have not.) Intravenous, or tube, feeding, bed rest, and intensive nursing care will probably be needed in order to restore the lost weight. At the same time, behavioral therapy is almost always called for to help change compulsive eating habits and obsessions concerning staying thin. In many cases, psychological counseling is also recommended for the parents and other family members. Often, the mother also has a history of an eating disorder. She may be overweight or put undue emphasis on being thin. Some psychiatrists theorize that an anorectic daughter may be fulfilling her parents’ unconscious desire that she remain a child. Hospitalization for bulimics is rare, except for some patients who are very depressed. Group therapy works well for many bulimics, who tend to be ashamed of their binging and so feel relieved to find they are not alone in this behavior. Once they are able to discuss the problem in a therapeutic setting, treatment is more likely to work for them. An antidepressant drug may be prescribed in conjunction with dietary and behavioral therapy.