ANOREXIA NERVOSA, BULIMIA

EATING DISORDERS

Two of the most serious eating disorders are anorexia nervosa, a complex disease characterised 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% 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 theorise that their eating behaviour represent 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 the 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 bulimic also abuse diuretics, drugs that increase excretion of body fluids; others abuse amphetamines to prevent weight gain.

Bulimic 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 bulimic also exhibit other addictive behaviour, 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.

Aneroxia 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 behaviour increases their risk of heart diseases.

DIAGNOSTIC STUDIES AND PROCEDURES

Even if an eating disorder is suspected, the first step is a complete physical examination to rule out other illnesses, such as cancer or a chronic infection, particularly if extreme weight loss has occurred. While conducting the examination, the doctor will look for signs of anorexia and bulimia.

Indicators of anorexia include dry skin, thinning and brittle hair, low blood pressure and a slow heart rate – all signs that the body is responding to starvation by shutting of or slowing down function that are not vital to sustaining life. Some anorectics complain of constipation and intolerance to cold and may even develop a soft body hair called lanugo as a response to the lower body temperature that occurs when body fat is lost. Another major symptoms of anorexia is the absence of menstruation, due to the loss of body fat and the resulting hormonal changes. Mild anemia, lightheadedness and sleep problems also suggests anorexia.

In diagnosing bulimia, the physical examination and medical history are also highly important. The doctor will look for damage to the teeth and gums caused by repeated exposure to the stomach acids in vomit. The esophagus maybe inflamed due to vomiting and glands near the cheeks might also be swollen. One or more fingers could be scarred as a results of pushing them down the throat to induce vomiting. And menstrual periods are likely to be irregular. The doctor will ask about dieting and exercise habits, as bulimics frequently diet and exercise incessantly without losing weight and generally regain weight if they do loose it.

MEDICAL TREATMENTS.

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 hospitalisation 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, behavioural therapy is almost always called for to help change compulsive eating habits and obsessions concerning staying thin.

In many cases, psychological counselling is also recommended for the parents and other family members. Often, the mother also has a history of an eating disorder. She maybe overweight or put undue emphasis on being thin. Some psychiatrists theorise that an anorectic daughter maybe fulfilling her parents unconscious desire that she remain a child.

Hospitalisation 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 behaviour. Once they are able to discuss the problem in a therapeutic setting, treatment is more likely to work for them. An anti depressant drug maybe prescribed in conjunction with dietary and behavioural therapy. Such drugs help control mood by increasing levels of serotonin (a brain chemical with a calming effect) in the circulation.

ALTERNATIVE THERAPIES

Biofeedback and Visualisation. These two techniques can be combined to reduce stress and help the person to create new thought patterns to control compulsive eating habits. During biofeedback training, she becomes aware of the body’s responses to compulsive behaviour, which enables her to control them. Visualisation involves “seeing” a desired response. The bulimic, for example, might learn to see herself eating a normal amount of food and than leaving the table feeling satisfied rather than guilty for over eating.

Hypnosis. Combined with other psychotherapeutic approaches, hypnosis and self- hypnosis can help the bulimic to control the impulse to binge and purge, and the anorectic to overcome the perception of being too fat.

Meditation. Yoga and other forms of meditation can help a person with and eating disorder to control stress, which is essential if treatment is to succeed.

Nutrition Theraphy. This is the key to overcoming any eating disorder. A nutrition counsellor can provide an understanding of the body’s needs for well balanced meals and point out the health hazards of overly restrictive diets. The binge eater and the anorectic both need to learn how to plan menus and set reasonable goals for eating and weight control. The anorectic must also learn to accept more normal concepts of what constitutes ideal weight, overweight and underweight, and to understand what the consequences of extreme thinness can be. Frequent sessions with a nutritionist maybe  necessary over a period of time, so that eating habits and weight can be monitored.

SELF TREATMENT

Because people with eating disorders typically deny their problems, ignoring symptoms and constructing elaborate strategies for deceiving others about their eating habits, self-treatment is usually not effective unless supported by some form of therapy. In general, people with eating disorder are unlikely to seek treatment on their own. Yet the earlier treatment begins, the more likely it is to be successful.

During psychotherapy, anorectics and bulimics gradually learn to stop denying that they have a problem and to set goals for maintaining normal eating habits. Family members may need counselling to understand how they can be helpful and how to avoid being misled or making the problem worse.

OTHER CAUSES OF WEIGHT LOSS

Many serious illnesses can cause weight loss and an emaciated appearance; these include cancer, heart disease, thyroid disorders and AIDS.

QUESTION TO ASK YOUR DOCTOR

> Is there anything I can do to help a person with an eating disorder who refuses to see a              doctor?

> The more I try to persuade my child to eat normally, the less food she seems to consume. What am I doing wrong?

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