More than 10 million Americans struggle with eating disorders. Once considered a “rich white girls’ disease”, eating disorders are now detectable in all social classes and an increasing number of cultures. Most frighteningly, anorexia, one of the two major types of eating disorders, has the highest premature fatality rate OF ANY MENTAL ILLNESS. Research shows that the majority of people with severe eating disorders do not receive adequate care: only 1/3 of people with anorexia and 6% of people with bulimia receive mental health care.

What are eating disorders? The DSM IV classifies anorexia (AN) and bulimia (BN) as the two major types. Additionally, the DSMIV includes “Eating Disorders Not Otherwise Specified (EDNOS)”, which includes Binge Eating Disorder and other eating disorders which do not fit into the anorexia and bulimia criteria.

1. Anorexia is characterized by self-starvation and excessive weight loss. The four diagnostic criteria are:
2. Resistance to maintaining a body weight at or above a normal weight for age and height Less then 85% of that expected
Failure to make expected weight gain during growth, leading to body weight less than 85% of expected.
BMI for age 5th percentile or below
3. Intense fear of weight gain, or being “fat” even though underweight
4. Disturbance in the experience of body weight or shape, undue influence of weight or shape on self-evaluation or denial of the seriousness of low body weightLoss of menstrual periods, post-puberty

Bulimia is characterized by a secretive cycle of binge eating followed by purging. The diagnostic criteria are:
1. Regular intake of large amounts of food accompanied by a sense of loss of control over eating behavior.
2. Regular use of inappropriate compensatory behaviors, including vomiting, laxative abuse, fasting, compulsive exercise.
3. Extreme concern with body weight and shape
a) Purging-type: regularly engages in self-induced vomiting or misuse of laxatives, diuretics or enemas
b) Non-purging type: regularly uses inappropriate compensatory behaviors such as fasting or excessive exercise

Binge Eating Disorder Not Otherwise Specified includes:
1) Binge-eating without purging
2) obesity
3) Excessive Exercising
4) All criteria for Anorexia except
a) Still has regular periods and/or
b) in normal weight range
5) All criteria for Bulimia except
a) Binge/purge less than 2 X/week or less than 3 months duration
b) Purging after small amounts of food (2 cookies)

Eating disorders have many precipitating factors, making them difficult to heal. Most researchers agree that bio-genetic factors, environmental factors, familial factors, and personality factors often combine to make a person highly susceptible. Although recovery rates vary, everyone agrees on this: the earlier a person with an eating disorder seeks treatment, the greater the likelihood of physical and emotional recovery. 85% of eating disorders begin during adolescence. Ideally then, treatment should start during in those early years. Unfortunately, because of the shame often associated with an eating disorder as well as its short-term benefits, few people willingly come forward during this phase. Educating mental health professionals, school personnel, and caregivers about the warning signs and potentially life-threatening consequences of eating disorders is thus vital, increasing possibility that people can be helped. *

Following is the typical progression of anorexia, including warning signs:
Anorexia often begins with dieting
Dieting becomes more and more rigid and includes skipping meals, drastically cutting calories, fat, and protein and becoming more picky
There is a denial of hunger/Refusal to eat
The person can become obsessed with food, cooking, and nutrition
Compulsive rituals begin and quickly increase; the obsession worsens
Exercise becomes excessive, sometimes up to 4 or 5 hours a day
The person offers consistent excuses for avoiding meals or situations involving food
Life/conversation is dependent on weight loss/gain
Anxiety about being “fat” worsens despite obvious thinness
Secrecy increases; isolation increases, including withdrawal from friends and usual activities
Obsession and denial worsens, as brain and other body functions shut down
The body shuts down. Death occurs.


Bulimia’s warning signs are:
Evidence of binge-eating: food disappears. Anywhere from 1,000 to 60,000 are consumed in one binge; sometimes,
The person uses bathroom and/or shower right after a meal; you may find trash bags or other containers filled with vomit
The bulimic exhibits puffiness, red eyes, red/callused knuckles and/or sore throat
There is evidence of purging: dirty bathroom, laxative boxes, diet pills
The person exercises rigidly and zealously
The bulimic exhibits dental erosion, staining
She creates a complex lifestyle schedule to facilitate bingeing and purging
She withdraws from friends and usual activities
There can be weight loss, though not always; dieting becomes a primary and constant concern

The way bulimia progresses is exemplified here:
It begins as an attempt to lose weight; body/psyche rebels; binge occurs
The binge leaves the bulimic exhausted and uncomfortable; he feels deep guilt and shame; hates this out-of-control person; goes against who he strives to be, ie perfect. Extra pounds will show who she “really is”
She has to UNDO the binge by purging: it seems to be the only antidote to the loss of control over food
Vomiting as a solution often begins almost by accident (reads about it, friends talk about it…)
Most people do this for a short time and can stop
For others, binge-purge cycle becomes addictive: what begins as a rare cycle can take up most of the person’s time. Recent research has found that serotonin gets released during the binge-purge cycle.
Many bulimics were prior anorexics

It is crucial to understand that eating disorders SERVE IMPORTANT FUNCTIONS. Uncovering those functions and finding healthier ways to fulfill them is crucial to successful healing

Below are some of anorexia’s important functions:
As the person loses weight, dieting and weight loss take on a different function
She/he finds a newfound control in life. She previously did not feel effective, especially as life is changing around her
She believes that being thin will solve all problems
She finds a new sense of power (does not have to give in to hunger); of superiority: she finally measures up
There is a new sense of meaning, purpose to life
She gets a new sense of challenge
She gets a new sense of independence, the “good girl” saying no to authorities, often for first time in life
Anorexia gives her an identity, which is often a fundamental developmental task.

Following are some of bulimia’s important functions:
“While I’m eating, nothing else matters” The bulimic can eat to satisfy emotional needs and not deal with the consequence.
Food is an outlet for all the feelings and conflicts that cannot be exposed;
Binge-purge blocks or lets out feelings that are experienced as unacceptable
The bulimia is a way to cope with uncomfortable emotional states; it relieves stress, anxiety, low-self-esteem
Unlike anorexic, the bulimic DOES acknowledge there’s something wrong but hopeless about what to do about it

Treatment possibilities are varied, though their effectiveness is not always corroborated by science. Educating yourself on the various modalities as well as being trained in the specifics of eating disorders is a big step in effectively helping those who struggle with eating disorders.

Here is some of the information we know:
Family therapy is the most successful type of treatment IF the child is under 18 AND lives at home
Cognitive-behavioral therapy has been studied extensively and offers strong positive outcomes, though not necessarily in the long-run
Dialectical Behavioral Therapy is increasingly used in hospitals and clinics to some success
The more support the client receives, the better her potential for recovery: a combination of individual, group, and family therapy is ideal though costly, as insurance only covers small, if any, portions of treatment.
Other forms of therapies are proving successful in healing eating disorders, including art therapy, equine therapy, energy healing, and massage therapy, to name a few
Pharmaceutical treatments can be effective for some but not all. SSRIs (anti-depressants) work especially well with bulimics.
Money is being poured into research to support that a person’s risk for developing eating disorders is genetic. The latest such study showed that more than half (56%) a person’s risk for developing anorexia is determined by genes, with environmental factors determining the rest.

* While there are a number of health consequences for anorexia, bulimia, and EDNOS, the length of this article does not allow me to focus on it. Please go to http://www.nationaleatingdisorders.org/ for further information.

posted by Isabelle | 12:21 PM