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Anorexia
Nervosa and
Bulimia Nervosa
Introduction
Everybody eats. We do so both because we need to and because we enjoy it.
However, as with all human behavior, there are huge differences between
people. Some eat more, some eat less, some put on weight easily, and others do
not. Some people go to such extremes that they harm themselves, by eating too
much or too little as a result they may harm their. This brochure deals with
anorexia nervosa and bulimia nervosa.
Although it is easier to talk
about them as different conditions, individual patients often suffer from
symptoms of both. Bulimia often
develops after a period of months or years of anorexic symptoms.
Women suffer from these
disorders 10 times as often as men. Although often thought of as adult
problems, these disorders most often start in the teenage years while the
sufferer is still at home
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- Fear
of fatness
- Under-eating
- Excessive
loss of weight
- Vigorous
exercise
- Monthly
periods stop
Anorexia usually starts in
the mid-teens and affects 1 fifteen-year-old female in every 150. Occasionally
it may start earlier, in childhood, or later, in the 30s or 40s. Females from
professional or managerial families are possibly more likely to develop it
than females from working-class backgrounds. Other members of the family have
often had similar symptoms.
Anorexia usually begins with
the everyday dieting that is so much a part of teenage life. About a third of
anorexia sufferers have been overweight before starting to diet. Unlike normal
dieting, which stops when the desired weight is reached, in anorexia the
dieting and the loss of weight continue until the sufferer is well below the
normal limit for her age and height. The tiny amount of calories that the
person is taking in may be disguised by the quantities of fruit, vegetables
and salads that they eat. Also,
anorexics’ will often exercise vigorously or take diet pills to keep their
weight low. In addition, in spite
of the anorexics’ own attitude to eating, they may take an avid interest in
buying food and cooking for others.
Although technically the word
anorexia means 'loss of appetite', sufferers with anorexia actually have a
normal appetite, but drastically control their eating.
As time wears on,
the patient’s with anorexia may develop some of the symptoms of
bulimia. They may then make themselves sick or use laxatives as ways of
controlling their weight. Unlike sufferers from 'pure' bulimia, their weight
will continue to be very low.
Bulimia Symptoms
- Fear
of fatness
- Binge-eating
- Normal
weight
- Irregular
periods
- Vomiting
and/or excessive use of laxatives
This condition usually
affects a slightly older age group, often women in their early to mid-twenties
who also have been overweight as children. It will affect 3 out of every 100
women at some time in their lives. Like anorexics, people with bulimia suffer
from an exaggerated fear of becoming fat. Unlike women with anorexia the
bulimic woman usually manages to keep their weight within normal limits. They
can do this because, although they try to lose weight by making themselves
sick or taking laxatives, they also 'binge eat'. This involves eating, in a
very short time, large quantities of fattening foods that they would not
normally allow themselves. For example, they might eat numerous boxes of
cookies, several boxes of chocolates and a number of pieces cake in two hours
or less. Afterwards they will make themselves sick, and feel very guilty and
depressed. This bingeing and vomiting may raise or lower her weight by up to
10Ib within a very short period of time. It is extremely uncomfortable, but
for many it becomes a vicious circle that they cannot break out of. Their
chaotic pattern of eating comes to dominate their lives.
Consequences
of Anorexia and Bulimia
Starvation:
- Broken
sleep
- Constipation
- Difficulty
in concentrating or thinking straight
- Depression
- Feeling
the cold
- Brittle
bones which break easily
- Muscles
become weaker -it becomes an effort to do anything
- Death
Vomiting
- Stomach
acid dissolves the enamel on teeth
- Puffy
face (due to swollen salivary glands)
- Irregular
heartbeats
- Muscle
weakness
- Kidney
damage
- Epileptic
fits
Laxatives
Causes
There are many different ideas about the causes of these two disorders
and it is important to stress that not all will apply to every sufferer.
Social
Pressure
In societies, which do not value thinness, eating disorders are very
rare. In surroundings such as ballet schools, where the value of thinness is
extreme, it is very common.
Generally in Western cultures 'thin is beautiful'. Television, newspapers and
magazines are full of pictures of thin, attractive young men and women. They
push miracle diets and exercise plans to enable us to mold our bodies to the
pattern of these artificial, idealized figures, to conform to the shape the
media tells us we should be. As a result, almost everybody diets at some time
or other. It is easy to see how this social pressure might cause some young
women to diet excessively and eventually to develop anorexia.
Control
It has to be said that dieting can be a very satisfying activity. Most
of us know the feeling of achievement when the scales tell us that we have
lost a couple of pounds! It is good to feel that we have managed to control
ourselves in a clear, visible way. It can be especially satisfying for in
teens that may feel their weight is the only part of their lives over which
they do have any control. So it is easy to see how dieting can become an end
in itself, rather than just a way of losing weight.
Puberty
A female with anorexia may lose or not fully develop some of the
physical characteristics of an adult woman, such as pubic hair, breasts and
monthly periods. As a result, they may look very young for their age. Dieting
can therefore be seen as a way of putting off some of the demands of maturing,
particularly the sexual maturity. Unfortunately, this condition makes it
difficult for female to develop the maturity and self-awareness that come from
facing and dealing with the problems of growing up.
Family
Eating is a most important part of our lives with other people.
Accepting food gives pleasure to whoever is providing it, refusing it will
often cause offence. This is particularly true within families! Some children
and teenagers seem to find that saying no to food is the only way they can
either express their feelings or have any influence in the family
Depression
Most of us are familiar with the experience of eating for comfort when
we are upset, or even just bored. Many sufferers with bulimia have depressive
symptoms and it may be that their binges started off as a way of coping with
feeling unhappy. However, feeling bloated will make these feelings worse,
while vomiting and purging leave a feeling of guilt.
Stessors
We all have different ways of
reacting to the bad things that happen to us in life. For some people,
anorexia or bulimia seem to be triggered off by an upsetting event, such as
the break-up of a relationship. Sometimes it need not even be a bad event but
just an important one, like marriage or leaving home
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Seeking
Help
In anorexia it is usually family members who realize that something is
wrong when they notice their sister or daughter is not only thin but also
continuing to lose weight. Although to others this weight loss appears
alarming and excessive, the sufferer will hardly ever admit that there is a
problem. Anorexics continue to believe that they are over-weight.
Others may not recognize the problem for some time because of the large
amounts of 'healthy' (but of course non-fattening) foods are being eaten.
In bulimia the sufferer often
feels guilty and ashamed of their behavior and may go to great lengths to hide
it. This is despite the fact that eating huge amounts of food and then
vomiting it back up is extremely time-consuming and exhausting. It may affect
their performance at work and will certainly make it difficult to lead an
active social life. So, it can be a huge relief finally to have to admit to
the problem.
Recognition
The first step to treating a disorder is recognizing it. It is much
easier to help somebody with anorexia or bulimia if the problem is spotted and
dealt with quickly. The longer
that it remains unrecognized, the worse the problem tends to become, and the
harder it is to help. Anorexia can be life threatening, so it is important to
see a physician.
Referral
Once the problem is recognized, the sufferer should be seen by a
psychiatrist or psychologist who has experience with these disorders. Your
family doctor will know whom to contact. Although until recently there has
been a tendency to admit people with anorexia to hospital, most can be treated
as outpatients if the weight loss is not too severe.
Assessment
The first step the psychiatrist will take is to have a long talk with
the patient to find out when the problem started and how it developed. This
will involve discussing many aspects of her feelings and her life. She will
need to be weighed. Depending on the loss of weight, a physical examination
and blood tests may be necessary. With their permission, the psychiatrist will
almost certainly want to talk with friends and family members, to see what
light they may be able to shed on the problem.
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Anorexia
If someone has become excessively thin and their periods have stopped,
it makes sense for them to try to get back to somewhere near an acceptable
weight. To help with this, both the patient and the family will first need
information. What is a 'normal' weight for her? How many calories are needed
each day to get there? For many sufferers, the most important question is,
"How can I make sure that I don't shoot past that weight and become
fat?” In anorexia, the patient has excessive control of their eating. How
can they ease up? For youngsters still living at home, it is the parents' job
to watch over the food that is eaten, at least for a while. This involves both
making sure that they have regular meals with the rest of the family, and that
they get enough calories. Mounds of lettuce can be very deceptive. It is also
important that the family gets support regularly both to check on weight and
for support.
Only if these simple steps do
not work, or if the weight loss threatens life, is admission to hospital
usually considered. In-patient treatment consists of much the same combination
of dietary control and talking, only in a much more structured environment.
Bulimia
Here, the priority is to get back to a regular pattern of eating. The
aim is to maintain a steady weight on three meals a day at regular times,
without either starving or vomiting. Sufferers are usually older than
anorexics and not living at home, so the emphasis is more on their keeping
diaries of their disordered eating habits and developing self-control. Again,
dietary information needs to be given so gaining too much weight doesn’t
discourage the sufferer. The other important part of treatment is psychotherapy -
talking about things in the past or the present that may have a bearing on the
eating disorder and other personal difficulties.
For those sufferers with
depression in addition to their bulimia, anti-depressant medication may be
necessary.
Self
Help
Having seen your doctor or specialist, you may find it helpful to join
a self-help group in which other people share similar problems. These groups
can provide both information and support during the difficult times that
everybody with these problems goes through. Your family doctor should be able
to recommend a suitable local group. Reading
can help to give you the information you need to eat sensibly, and to know
what a reasonable weight is for you.
This
brochure was adapted by Duke University Medical Center Department of
Psychiatry from The Royal College of Psychiatrists
©
Copyright The Royal College of Psychiatrists. Reprinted with permission by the
Computers in Psychiatry Special Interest Group and Department of Mental
Health, University of Exeter.
Original
Brochure produced with the help of an educational grant from Eli Lilly and Co.
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