Anorexia

Each year millions of people in the United States are
affected by serious and sometimes life-threatening eating
disorders. The vast majority are adolescents and young
adult women. Approximately one percent of adolescent girls
develop anorexia nervosa, a dangerous condition in which
they can literally starve themselves to death. Another two
to three percent develop bulimia nervosa, a destructive
pattern of excessive overeating followed by vomiting or
other " purging " behaviors to control their weight. These
eating disorders also occur in men and older women , but
much less frequently. 

The consequences of eating disorders can be severe. For
example, one in ten anorexia nervosa leads to death from
starvation, cardiac arrest, or suicide. Fortunately,
increasing awareness of the dangers of eating disorders,
sparked by medical studies and extensive media coverage,
has led many people to seek help. Nevertheless, some people
with eating disorders refuse to admit that they have a
problem and do not get treatment. Family and friends can
help recognize the problem and encourage the person to seek
treatment. 

Anorexia nervosa is a disorder where people intentionally
starve themselves. It usually starts around the time of
puberty and involves extreme weight loss. Sometimes they
must be hospitalized to prevent starvation because food and
weight become obsessions. For some, the compulsiveness
shows up in strange eating rituals, some even collect
recipes and prepare gourmet feasts for family and friends.
Loss of monthly menstrual periods is typical in women with
this disorder and men with this disorder usually become
impotent.
 
People with bulimia nervosa consume large amounts of food
and then rid their bodies of the excess calories by
vomiting, abusing laxatives or exercising obsessively. Some
use a combination of all these forms of purging. Many
individuals with bulimia " binge and purge " in secret and
maintain normal or above normal body weight. They can often
successfully hide their problem from others for years. As
with anorexia, bulimia typically begins during adolescence.
The condition occurs most often in women but is also found
in men. Many individuals with bulimia, do not seek help
until they reach their thirties or forties. By then, their
eating behavior is deeply ingrained and more difficult to
change.
 
Medical complications can frequently be a result of eating
disorders. Individuals with eating disorders who use drugs
to stimulate vomiting, may be in considerable danger, as
this practice increases the risk of heart failure. In
patients with anorexia, starvation can damage vital organs
such as the heart and brain. To protect itself, the body
shifts into " slow gear ": monthly menstrual periods stop,
breathing, pulse and, blood pressure rates drop, and
thyroid function slows. Nails and hair become brittle, the
skin dries, yellows, and becomes covered with soft hair
called lanugo. Excessive thirst and frequent urination may
occur. Dehydration contributes to constipation, and reduced
body fat leads to lowered body temperature and inability to
withstand cold. Mild anemia, swollen joints, reduced
muscles mass, and light headedness also commonly occur in
anorexia. If the disorder becomes severe, patients may lose
calcium from their bones, making them brittle and prone to
breakage. 

Scientists from the National Institute of Mental Health (
NIMH ), have also found that patients suffer from other
psychiatric illnesses. They may suffer from anxiety,
personality or substance abuse disorders, and many are at a
risk for suicide. Obsessive compulsive disorder, an illness
characterized by repetitive thoughts and behaviors, can
also accompany anorexia.
 
Bulimia nervosa patients- even those of normal weight- can
severely damage their bodies by frequent binge eating and
purging. In rare instances, binge eating causes the stomach
to rupture, purging may result in heart failure due to loss
of vital minerals, such a potassium. Vomiting causes other
less deadly, but serious, problems. The acid in vomit wears
the outer layer of the teeth and can cause scarring on the
backs of hands when fingers are pushed down the throat to
induce vomiting. Further the esophagus becomes inflamed and
glands near the cheeks become swollen. As in anorexia,
bulimia may lead to irregular menstrual periods and
interest in sex may also diminish. 

Some individuals with bulimia struggle with addictions,
including abuse if drugs and alcohol, and compulsive
stealing. Like individuals with anorexia, many people with
bulimia suffer from clinical depression, anxiety obsessive
compulsive disorder, and other psychiatric illnesses. These
problems place them at high risk for suicidal behavior.
People who binge eat are usually overweight,so they are
prone to medical problems, such as high cholesterol, high
blood pressure, and diabetes. Research, from the NIMH
scientists, has shown that individuals with binge eating
disorder have high rates of co-occurring psychiatric
illnesses, especially depression.
 
Eating disorders are most successfully treated when
diagnosed early. Unfortunately, even when family members
confront the ill person about his or her behavior, or
physicians make a diagnosis, individuals with eating
disorders may deny that they have a problem. Thus, people
with anorexia may not receive medical or psychological
attention until they have already become dangerously thin
and malnourished. People with bulimia are often normal
weight and are able to hide their illness from others for
years. Eating disorders in males may be overlooked because
anorexia and bulimia are relatively rare in boys and men.
Consequently, getting and keeping people with these
disorders into treatment can be extremely difficult.
 
In any case, it cannot be overemphasized how important
treatment is for the people who have these disorders. The
longer eating behaviors persist, the more difficult it is
to overcome the disorder and its effect on the body. If an
eating disorder is suspected, particularly if it involves
weight loss, the first step is a complete physical
examination to rule out any other illnesses. Once an eating
disorder is diagnosed, the clinician must determine whether
the patient is in immediate medical danger and requires
hospitalization. While most patients can be treated as
outpatients, some need hospital care. Conditions warranting
hospitalization include excessive and rapid weight loss,
serious metabolic disturbances, clinical depression or risk
of suicide, severe binge eating and purging, or psychosis. 

The complex interaction of emotional and physiological
problems in eating disorders calls for a comprehensive
treatment plan, involving a variety of experts and
approaches. Ideally, the treatment team includes an
internist, a nutritionist, an individual psychotherapist,
and a psychopharmacologist. To help those with eating
disorders deal with their illness and underlying emotional
issues, some form of psychotherapy is usually needed. Group
therapy, in which people share their experiences with
others, has been especially effective for individuals with
bulimia.
 
NIMH supported scientist, have examined the effectiveness
of combining psychotherapy and medications. In a recent
study of bulimia, researchers have found that both
intensive group therapy and antidepressants medications,
combined or alone, benefited patients. In another study of
bulimia, the combined use of cognitive behavioral therapy
and antidepressant medications was most beneficial. This
combination treatment was particularly effective in
preventing relapse once medications were discontinued. For
patients with binge eating disorder, cognitive behavioral
therapy and antidepressant medications may also prove to be
useful. For anorexia, preliminary evidence shows that some
antidepressant medications may be effective when combined
with other forms of treatment. Fluoxetine has also been
useful in treating some patients with binge eating disorder
and depression.
 
The efforts of mental health professionals need to be
combined with those of other health professionals to obtain
the best treatment. Physicians treat any medical
complications, and nutritionists advise on diet and eating
regimens. The challenge of treating eating disorders is
made more difficult by the metabolic changes associated
with them. Just to maintain a stable weight, individuals
with anorexia may actually have to consume more calories
than someone of similar weight and age without an eating
disorder. This is important, because consuming calories is
exactly what the person with anorexia wishes to avoid, yet
must do to regain the weight necessary for recovery. In
contrast, some normal weight people with bulimia may gain
excess weight if they consume the number of calories
required to maintain normal weight in others of similar
size and age.
 
Treatment can save the life of someone with an eating
disorder. Friends, relatives, teachers, and physicians all
play an important role in helping the ill person start with
a treatment program.
 
Encouragement, caring, and persistence, as well as
information about eating disorders and their dangers, may
be needed to convince the ill person to get help, stick
with treatment, or try again.
 
Family members and friends can call local hospitals or
university medical centers to find out about eating
disorder clinics and clinicians experienced in treating the
illnesses, for the college students, treatment programs may
be available in school counseling centers.
 
Family and friends should read as mush as possible about
eating disorders, so they can help the person with the
illness understand his or her problem. Many local mental
health organizations and the self help groups provide free
literature on eating disorders. Some of these groups also
provide treatment program referrals and information on
local self help groups. Once the person gets help, he or
she will continue to needs lots of understanding and
encouragement to stay in treatment.
 
NIMH continues its search for new and better treatments for
eating disorders. Congress has designated the 1990's as the
" Decade of the Brain, " making the prevention, diagnosis,
and treatment of all brain and mental disorders a national
research priority. This research promises to yield even
more hope for patients and their families by providing a
greater understanding of the causes and complexities of
eating disorders.