What Are They?

Eating disorders are characterized by gross disturbances in eating behavior. ANOREXIA is diagnosed when a person refuses to maintain a normal body weight or is unable to stop losing weight; is intensely fearful of gaining any weight even if underweight; sees oneself as fat even when underweight; and in women, when menstrual periods stop occurring.

Extreme weight loss occurs because one ‘feels fat," so strictly reduces tbod intake and usually exercises excessively in order to burn off ‘extra’ calories. Many anorexics cannot maintain the caloric restriction they believe they "should" in order to prevent weight gain so will turn to laxatives, diet pills and/or diuretics.

BULIMIA is similar to anorexia in that bulimics also have an extreme fear of fat and an excessive concern with body shape and weight. The difference between the two disorders is that bulimics engage in bingeing and purging. A binge is defined as the rapid consumption of large amounts of food within a short period of time. During the binge there is the distinct feeling of being out of control and unable to stop the eating episode. Because a binge creates such physical discomfort, some form of purging usually follows to relieve that discomfort. Vomiting is the most commonly known form of purging. Less recognized, but equally as prevalent forms of purging include laxative abuse, diuretic abuse, excessive exercise and strict dieting. For the bulimic, the purpose of purging is to get rid of all the calories consumed during the binge in order to prevent weight gain.

Why Do They Happen?

Those with eating disorders believe their only problem is that they are fat and need to lose weight. Working from that frame of reference, their thoughts become totally consumed with dieting, calories, the number on the scale, how much they can exercise, how to hide their rail thin bodies or their shameful bingeing and  purging behaviors so others do not find out, etc. 

Why would someone become so consumed with their weight? When the majority of time is spent obsessing about food, weight and exercise, there is no time to think about feelings. Many people with eating disorders come from dysfunctional families, have low self-esteem even though they are high achievers, may have experienced some form of sexual trauma during their lifetime, suffer from other emotional problems such as depression, and generally feel their lives are  out of control.

Because feelings associated with the above problems are often times debilitating and create the sense of being out of control, body weight is focused on as something that can be controlled. Anorexics and bulimics believe that if they could just lose 5 more pounds they would he happier, more successful, accepted by others, etc. Everything in their lives eventually becomes contingent on what they weigh. The ironic aspect about eating disorders is that in the attempt to gain control by manipulating food and exercise, the more out of control one gets in all other areas of life.
        
The Effects of Starvation

For those who are truly overweight, the typical diet prescription is to decrease caloric intake and increase energy expenditure; in other words, eat less and exercise more. When this prescription is taken to the extreme by one who is of normal weight or underweight, the opposite effect of what is expected eventually occurs. It is expected that by eating fewer calories and by exercising to burn calories, body fat will be eliminated.  However, when the body is in a state of starvation, the first thing to be metabolized is muscle tissue and the last  thing metabolized is fat. This means that excessive diet, exercise and/or purging forces the body to literally metabolize or eat itself because it is not receiving any  fuel or food. Anorexics and bulimics often state that all  they see on their bodies is fat. This is in effect true  because the muscle mass has significantly deteriorated and there is less muscle tone to give their bodies any shape.
        
Eating disordered behaviors are further reinforced when  an attempt is made to eat normally again. Because the  body is in a state of starvation, the metabolic rate drops, the body stores whatever fuel it is given, and weight gain  occurs. This is interpreted as "If I eat I will keep gaining weight and never stop so Ijust won’t eat." In reality, when the body recognizes it is receiving regular and  consistent nutrition, the metabolic rate will increase and weight gain will stabilize within the normal weight range.

Medical and Physical Problems

In addition to the physical changes are the physiological consequences of eating disorders, many of which are life threatening. Because the heart is a muscle, it too deteriorates when the body is starved, thereby increasing the risk of cardiac arrest. Other common problems include dehydration, dizziness, fainting, muscle weakness, abdominal pain, irregular heart rhythms, swollen glands, liver and kidney failure and always feeling cold no matter what the temperature.
        
The malnutrition caused by eating disorders intensifies irritability, mood swings, the inability to concentrate and depression. This creates problems at work and in other relationships, thereby impeding the happiness and success the thin body is expected to attract. This cycle sets the eating disordered person to strive for more weight loss. They believe they are having difficulties because they just have not lost enough weight and are still too fat, and do not recognize they are having difficulties because they have lost too much weight and are barely functioning physically or mentally.

Getting Help For Anorexia and Bulimia

The treatment of eating disorders is very challenging. It is usually long-term because treatment is often not sougl~it until the condition has been in existence for several years. Additionally, one must relearn how to deal with food in an adaptive manner and overcome the notion that food is the enemy.
        
In addition to focusing on normal eating, underlying emotional issues must also be addressed. The typical phrase "Nothing is wrong with me, I just feel fat" is heavily confronted because "fat" is not a feeling. "Feeling fat" is nothing more than a way to avoid feeling depressed, guilty, angry, scared, ashamed, lonely, powerless, overwhelmed, etc.

While the attempt is to avoid these kinds of emotions, ironically, the secretiveness of eating disordered behaviors exacerbates them and the anorexic or bulimic unknowingly intensifies all the feelings they are seeking to escape. Clearly, controlling food is not the issue, but rather the way internal conflicts are manifested.
        
If you recognize eating disordered behaviors in someone you know, do not ignore the problem -- it will not go away, it will only get worse. Confront the person with what you see and what you know.  Help the person find a psychologist who specializes in treating eating disorders -- ask about their credentials, experience and treatment methods. Not  all therapists are qualified to treat these complex and difficult disorders.

Warning Signs:

• Rapid or extreme weight loss
• Continued dieting even though under normal weight
• Preoccupation with food, weight, calories, exercise
• Excessive concern about appearance I body image
• Distorted eating patterns: Skipping meals, eating in secret, ritualistic eating behaviors, strict dieting
• Excessive exercising
• Disappearing to the restroom after every meat
• Feeling sick or bloated after eating a normal meal
• Perfectionism; rigid, inflexible routines
• Withdrawal from friends and activities
• Low self-esteem
• Change in personality
• Mood swings
• Manipulative, sneaky behaviors
• Wearing baggy clothes to hide the body
• Overeating with no weight gain
• Loss of menstrual periods
• Refusal to eat with others or attend social events

Please review the following articles to learn more about eating disorders and effective methods of treatment.