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.