EATING DISORDERS

Some people have medically identifiable, potentially serious difficulties with body images, body weight, and food selection.  Among these disorders are two that are frequently seen among college students – anorexia nervosa and bulimia nervosa.  In addition, binge eating and disordered eating are also found in college populations.  However, most eating disorders also involve inappropriate food choices and psychological issues.

In the United States, conservative estimates indicate that after puberty 5 to 10 million females and 1 million males are struggling with eating disorders such as anorexia, bulimia, or binge eating disorder.  It is estimated that approximately 8% of college women will develop an eating disorder, and the population most at risk for developing bulimia is college freshmen women. 

Ninety to 95% of people with eating disorder are women, although the prevalence of eating disorders in men is on the rise.  Athletes such as dancers, gymnasts, swimmers, runners, and wrestlers are at risk for developing eating disorders because of the focus on weight and appearance for successful performance.  In fact, any group in which success is influenced by weight or attractiveness is at risk for the development of an eating disorder, such as those involved in the performance arts, theatre, television, and modeling.

Anorexia Nervosa

Anorexia Nervosa is an eating disorder in which a person denies his or her own feelings of hunger and avoids food, with marked weight loss occurring.  Anorexics tend to run from food in the relentless pursuit of thinness although they perceive themselves as never thin enough.  To meet the diagnostic criteria for anorexia nervosa, the individual has an intense fear of gaining weight, even though he or she weighs less than 85% of the expected weight for his/her age, gender, and height, and, in females, menstruation ceases for at least three consecutive months.  In addition, people with anorexia perceive themselves as overweight and much larger than what they look like in reality.  Anorexics lose their ability to recognize when they are hungry and have difficulty eating even if they want to do so. Depression, irritability, withdrawal, perfectionism, and low self-esteem are some of the psychological problems associated with anorexia.  In addition, anorexia tend to feel cold most of the time because they have very little body fat (2 – 10%) and also suffer from lightheadedness, dizziness, insomnia, hair loss, muscle cramps, stress fractures, fatigue, decreased memory and concentration, and gastrointestinal problems.  More serious complications include heart and kidney failure, hypothermia, osteoporosis, infertility, and, in 25% of cases, death.

As with other eating disorders, anorexia nervosa also involves a sense of feeling out of control in one’s life and attempting to find control through food and weight loss.  It is not coincidence that anorexia nervosa typically begins around puberty: Most individuals with anorexia have a fear of growing up and all that goes with being an adult, such as financial responsibility, sexual relationships, leaving one’s family, and becoming more autonomous and independent.

Anorexia often begins with dieting, but may also begin with as a result of an illness such as the stomach flu, a relationship that breaks up, or after dental surgery in which it might be expected that one would temporarily eat less.  However, anorexics will tell you that the disorder begins to take on a life of its own after what started as wanting to lose a few pounds turns into losing 15% or more of body weight and still not feeling satisfied with one’s appearance.  Friends and family might initially encourage the person on his or her weight loss and say complimentary things about his or her appearance, but soon become concerned when the person’s weight continues to dramatically decrease.

Anorexia has become more common as changing cultural ideals for beauty has changed.  Our standards have gone from Marilyn Monroe who was a voluptuous 5’5”, 128-pound woman to Kate Moss who has been reported to be 5’7” and 105 pounds.  Now the “lollipop look” is considered the “in look” in Hollywood, with actresses and models having stick-thin bodies, making their heads seem huge.

Denial of problems plays a major role in eating disorders in which the individual refuses to acknowledge that there is anything wrong, even she is becoming thinner and wasting away, and family and friends are expressing great concern.  While anorexia nervosa is considered a serious medical and psychological disorder, some anorexics argue that “Anorexia is a lifestyle not a disorder.”  These heated debates and discussions often occur through pro-anorexia websites.  With names like “Thinspiration,” “Stick Figures,” and “Anorexic and Proud,” these pro-anorexia forums have become very popular and deadly in the past few years.  These websites show computer-enhanced pictures of models and actresses like Calista Flockhart and Lara Flynn Boyle, maing them appear thinner and more skeletal than they really are.

Messages on these websites include tips for how to starve, how to purge, ways of hiding one’s disorder, and encouragement to lose more weight.  There has been a push among health providers, educators, and health organizations to eliminate these types of websites, and they have been somewhat successful.  However, these sites are purported to still exist, although more disguised and underground than in the past.

Most recently, the three groups that have traditionally been overlooked in the incidence of anorexia are women of color, female athletes, and men.  The research shows a significant increase in the incidence of anorexia among these three groups.  More focus has been given to anorexia among women of color, and it has been proposed that this group might be more vulnerable to developing eating disorders than Caucasian women because of ethno-cultural identity issues.  It has been suggested that the more pressure women of color feel top fit into the dominant culture’s standards of beauty and thinness, the more likely they are to develop eating disorders.

Often female athletes are not diagnosed with eating disorders because the symptoms of anorexia, absence of menses, low body fat and weight, and osteoporosis, referred to as the “female athletic triad” are uncommon among athletes and don’t signify the presence of an eating disorder.

The prevalence of anorexia nervosa (as well as bulimia nervosa) has traditionally been very low in men as compared with women.  Today, however, the incidence of both conditions is increasing in men as they begin to feel some of the same pressures that women feel to conform to the weight and body composition standards imposed by others.  The “lean look” of young men models serves as a standard for more and more young men, whereas the requirements to “make weight” for various sports drives others.  Runners, jockeys, swimmers, and gymnasts frequently must lose weight quickly to meet particular standards for competition or the expectations of coaches and trainers.  Researchers report that men are less inclined than women to admit that they may have an eating disorder, thinking it is a “women’s illness.”  Thus they are less likely to seek treatment.  In addition, physicians tend not to suspect men as having eating disorders, and so they go untreated.

Fortunately, psychological treatment in combination with medical and dietary interventions can return the person with anorexia nervosa to a more life-sustaining pattern of eating.  The person with anorexia needs to receive the care of professionals experienced in the in the treatment to take 3 to 5 years.  If others, including friends, coworkers, roommates, and parents observe this condition, they should consult a health care provider for assistance.

Bulimia Nervosa

While anorexics are underweight, people with bulimia nervosa often are of a normal weight.  These individuals use food and weight as way of coping with stress, boredom, conflict in relationships, and low self-esteem.  It is not uncommon in our society to comfort ourselves with food, to have social activities based around food, and to eat as a way of procrastinating a dreaded activity.  However, people with bulimia take this to the extreme engaging in recurrent bingeing, consuming unusually large amounts of food and feeling out of control with their eating.

While anorexics run away from food, bulimics run to food to cope with their emotions problems, and stress.  Because they feel so guilty, ashamed, and anxious about the food they have consumed, people with bulimia purge by self-induced vomiting, taking an excessive number of laxatives and diuretics, excessively exercising or fasting.  There is a strong preoccupation with weight, calories, and food among sufferers of bulimia.  Most people with bulimia constantly count calories, weigh themselves throughout the day, and frequently make negative statements concerning different parts of their bodies, primarily focusing on the thighs, stomach, and waist.  As with anorexia, bulimia is associated with depression, isolation, anxiety, perfectionism, and low self-esteem.  Dental erosion, hair loss, esophageal lesions, blood in the vomit and stools, loss of voluntary gag reflex, kidney damage, heart failure, gastrointestinal problems, ketosis, edema, infertility, parotid gland swelling, depression, and insomnia are just some of the medical problems associated with bulimia nervosa.

As has been mentioned previously, bulimia often begins around age 17 to 18 years of age when young adults are separating from their families and are forging lives of their own.  There may be some conflict around issues of independence, autonomy, and relationships with family.  There is a higher incidence of bulimia than anorexia, although some bulimics may have had anorexia in the past.  There is also a higher rate of bulimia among female college students as compared to their peers who are not attending colleges.  Treatment for bulimia nervosa involves nutritional counseling, psychological treatment, and consultation with a physician.  Often people with bulimia can recover from this disorder within a year of beginning treatment.

Binge Eating Disorder

Binge eating disorder is the newest term for what was previously referred to as compulsive overeating.  Binge eaters use food to cope in the same way that bulimics do and also feel out of control and unable to stop eating during binges.  People with this disorder report eating rapidly and in secret or may snack all day.  They tend to eat until they feel uncomfortably full, sometimes hoarding food and eating when they aren’t physically hungry.  Like people with bulimia, they feel guilty and ashamed of their eating habits and have a great deal of self-loathing and body hatred.  People who have binge eating disorder do not engage in purging behavior and this is what differentiates it from bulimia nervosa.  Typically, binge eaters have a long history of diet failures, feel anxious, are socially withdrawn from others, and are overweight.  Heart problems, high blood pressure, joint problems, abnormal blood sugar levels, fatigue, depression, and anxiety are associated with binge eating.  The treatment of this eating disorder involves interventions similar to those described for treating bulimia nervosa.

Chewing and Spitting Out Food Syndrome

Chewing and spitting out one’s food without swallowing it has also been used as a method for weight loss or weight management.  This is a common eating disorder and falls within the “Eating Disorder Not Otherwise Specified” diagnosis.  It differs from bulimia nervosa and researchers contend that chewing and spitting out food without swallowing may indicate a more severe eating disorder.

Night Eating Syndrome

Night eating syndrome has not been formally defined as an eating disorder.  The signs and symptoms of this syndrome include: eating more than half of one’s daily food intake after dinner and before breakfast, feeling tense, anxious, and guilty while eating, difficulty falling or staying asleep at night, and having little to no appetite in the morning.  Unlike binge eating, night eating involves eating throughout the evening hours rather than in short episodes.  It is important to note that there is a strong preference for carbohydrates among night eaters.  Some researchers speculate that night eating may be an unconscious attempt to self-mediate mood problems because eating carbohydrates can trigger the brain to produce so-called “feel good” neurochemicals.  Research is underway in examining the underlying causes of this syndrome and developing subsequent treatment interventions.  It seems likely that a combination of biological, genetic, and psychological factors contribute to this problem.

Treatment for Eating Disorders

The treatment for eating disorders is multimodal and multidimensional involving nutritionists, psychologists, physicians, family, and friends.  There are different treatment modalities such as individual, group, and family counseling.  Sometimes treatment requires in-patient hospitalization to medically stabilize the individual.  In extreme cases, a feeding tube may be inserted to treat starvation, especially if the person refuses to eat.  Behavioral modification and cognitive therapy are utilized in counseling people with eating problems.  Medications such as antidepressants are often used to decrease obsessive compulsive behavior, reduce anxiety, alleviate depression, and improve mood.  Some medications can stimulate or reduce appetite as well.  There is some debate over the efficacy of using an addictions model, similar to the twelve step Alcoholics Anonymous utilizes this model in helping people with eating problems and many hospital programs employ this model in their treatment programs.  While there seems to be some overlap with substance abuse problems such as denial of problems, feeling out of control of one’s behavior, and using food or drugs or alcohol to cope with problems, this is where the similarities end as obviously end as obviously one needs food to live which is not the case with drugs and alcohol.