Treatment for Eating Disorders
Anorexia, Bulimia, Binge Eating Disorder
Anorexia, Bulimia, Binge Eating Disorder Facts
An eating disorder is basically an out-of-kilter relationship that one has with food; a psychological condition defined by one’s day-to-day interaction with what one consumes: either too little or too much. The term “eating disorder” is an umbrella expression to cover a number of different conditions, which we will describe, but basically they all have one thing in common and that and that one thing is an abnormal relationship with eating. Eating should be one of life’s pleasures—or at least something that one does without really thinking about too much—but to somebody suffering with an eating disorder, food is a nightmare.
Many people think of people with an eating disorder as somehow weak or stupid. Why on earth would someone starve him/herself to death or binge eat until they vomit? But the reality is that those caught up in eating disorders no longer have control over what they are doing. An eating disorder is a disease that needs treatment exactly the same as any other disease. Untreated eating disorders can, in the worst case scenario, cause multiple kinds of illness and even death. Suffering from an eating disorder means that you are not eating healthily, to put it mildly. Oftentimes you are not eating at all, and you’re literally starving yourself to death.
There are treatments for eating disorders and as with any illness, the sooner that an eating disorder is diagnosed the better chance there is of dealing with it and the underlying causes that brought it on in the first place.
Underlying Causes of Eating Disorders
There is really no set cause or reason why someone would develop an eating disorder, and the exact cause of the condition is still unknown. There are some common factors that those who have an eating disorder tend to share though, grouped into three main factors. These factors are as follows:
- Psychological factors: It’s extremely rare for someone “well balanced” and happy in life to develop an eating disorder. An eating disorder can be considered as a form of self-harm or self-abuse, and as such often develops in people suffering psychologically in some form or another. Depression, feelings of low self-esteem, stress, lack of control or a sense of overall inadequacy can sometimes lead to the development of an eating disorder of one kind or another. Hating yourself and the way you look is a major cause of eating disorders, and that self-hatred can either come from inside or from others.
- Biological factors: Scientists are exploring the premise of whether eating disorders are hereditary or not, at least in some cases, as it has been shown that the condition often runs in families. There is recent evidence that genetics can play a major part in whether someone develops an eating disorder or not. A 2013 study conducted by the University of Iowa with the University of Texas Southwestern Medical Center found that people with certain (very rare) mutations of two genes—ESRRA and HDAC4—had at least an 85 percent chance of developing an eating disorder at some point in their lives. There are also questions about whether chemical imbalances in the brain can contribute to an eating disorder or not, specifically imbalances in the chemicals that control one’s hunger and appetite.
- Environmental/social factors: This is a big one and ties into the psychological factors touched on above. In the western world, we are under constant pressure for that “perfect body”. In a society where obesity is more of a problem than it ever was in previous years, we are being told that fat is ugly and thin is beautiful. We are bombarded by advertising hoardings and TV commercials showing beautiful models telling us that we could look like them as well. For many people, they compare how they look unfavorably with how the idea of how they should look, leading to the self-esteem issues that can trigger an eating disorder. Outside of the media images that tell us how we should look, we also face peer pressure from our friends, especially teenagers. Other environmental/social factors can come from early abuse or trauma suffered leading to the self-harm that is an eating disorder.
It needs to be stressed that any given person with any given eating disorder may not be suffering from their disorder because of any one of the above factors—in reality the truth is more opaque and it’s often a combination of all or some of them that pull the trigger into a full-fledged disorder. It’s also true that someone can experience any or all of the factors that it’s believed lead to eating disorders, and not have a disorder at all. In the end it’s all down to the individual person.
Prevalence of Eating Disorders
So how common are eating disorders and who is getting them? The typical image of someone suffering from an eating disorder is a teenage girl or young woman, and that stereotype is pretty much about right. The majority of people who succumb to an eating disorder are girls and women between the ages of 12 and 25 years old. There are certainly cases outside of this age group but most will fall into it. Females are estimated to be 2.5 times more likely than males to develop an eating disorder.
It’s a gross oversimplification to just use the umbrella term “eating disorder” and blithely say that it mainly affects women. Although the stereotype—like most stereotypes—does have some basis of truth to it, in reality everyone is susceptible to developing an eating disorder, and studies have shown that age, gender, race, and sexuality all contribute to various different kinds of disorders.
For example, young white women (the stereotypical victims of eating disorders) are indeed more likely to develop anorexia nervosa while black women and Latino women are more likely to suffer from binge-eating disorders or bulimia nervosa.
In a world where the western image of beauty is considered the best, a study in 1996 showed that Asian, black, and Latino seventh-grade girls were more likely than white girls to be dissatisfied with their body shapes, which could lead to possible problems in the future.
Men also suffer. Although the overall numbers of men with eating disorders in general are less than that of women, when it comes to certain specific disorders such as binge-eating disorder, men and women are around equally affected by this condition.
Crunching the numbers a little in order to get some perspective on eating disorders, it’s worth displaying the following facts and statistics:
- There are currently 10 million women in the United States struggling with an eating disorder compared to just 1 million men.
- Forty percent of Americans have either suffered from an eating disorder or know somebody who has.
- Half of all teenage girls have practiced unhealthy weight control techniques such as fasting or using laxatives; while 30 percent of teenage boys have practiced the same thing.
- 25 percent of college-aged women have tried to manage their weight through binging and “purging”.
The above points go some way to show how prevalent eating disorders are in the USA in a general way. But in order to understand more about this condition it’s time to move beyond generalities and get much more specific.
“Online one will find lighthearted, but sometimes offensive, jokes about the serious issue of eating disorders (left), and alarming accounts of persons who are not yet ready to admit their eating disorder is a serious health problem (right).”
Types of Eating Disorders
The American Psychological Association recognizes three distinct different types of eating disorder, which will be outlined below, describing the disorder itself, giving some info as to who actually gets that specific type of disorder, offering typical signs and symptoms of the disorder, and finally some suggestions on treatment. Also outlined will be some general info on the struggles that many people endure to keep to the weight that they want and how occasionally those struggles can slip into something a lot more serious such as an eating disorder.
When one thinks of an eating disorder, it’s more than likely that they are conjuring up the image of an anorexic in their mind. Anorexia is the motherload of eating disorders—the big one, the one that everyone talks about. It’s the most deadly of all eating disorders, indeed the most deadly of any mental illnesses, with 4 percent of those affected by anorexia dying from complications connected to it, or dying as a result of suicide linked to the feelings of helplessness and despair that are brought on by the anorexia in the first place.
There is a certain type of person who gets anorexia. It’s normally the “control freak” or the overachieving perfectionist who everybody thinks can do no wrong. Oftentimes anorexia is not actually about food, but more about being that ideal person in your mind that you are not. It’s about control in a lot of situations.
There are two types of anorexia, as well, both with the same outcome. Restricting anorexia: where the anorexic refuses to eat at all; and purging anorexia: where the anorexic will eat and then immediately purge the food from their stomachs with laxatives or through vomiting. Either way, the nutrients needed to maintain the body do not stay in and so starvation ensues.
Anorexia nervosa isn’t simply the act of starving yourself in order to reach a desired weight that you have in your mind as ideal for you. An anorexic loses complete touch with his or her reality and will always see him/herself as overweight, no matter how thin he or she actually is. In the mind of an anorexic he/she will never reach his/her desired weight, causing more starving of him/herself and sinking more into a spiral of despair.
The end result of untreated anorexia is death. The body, starved of calories and nutrients eventually shuts itself down.
Anorexia is the stereotypical eating disorder, and as such affects women more than men. It’s estimated that between 90 to 95 percent of sufferers of anorexia will be females, it begins mostly in teenagers and women entering their early 20s. There are certain signs and symptoms that could indicate a problem with anorexia and these include the following:
- Obsession with the bathroom scales—consistently weighing themselves
- Becoming obsessed with calorie counting
- Skipping meals—always having an excuse for not having eaten (“not hungry”, “already eaten”, etc.)
- Playing with food on the plate rather than eating it (for example cutting food into tiny pieces, moving it around the plate, doing everything to it except for putting it in their mouth)
- Becoming obsessed with exercise and burning off calories
- Thinking that they are fat or overweight when the opposite is plainly true
- Withdrawal from usual family or social life, friends and activities
- Moodiness and lack of tolerance
- Becoming increasingly “high maintenance” and setting high, if not impossible standards.
The signs above are warning signs that someone might be, or be on the way to being, anorexic. Below are some physical signs of anorexia, which added to the warning symptoms above give serious cause for concern:
- Rapid weight loss
- Loss of hair
- Brittle nails
- Weakness and general loss of muscle strength
- Bad breath
- Lack of concentration on anything
- Low tolerance of cold—feeling cold all of the time as the body temperature drops
- The growing of a downy hair (called Lanugo) all over the face and the body in order to try to keep the body warm.
The above signs are all physical signs of the body starving itself and shutting itself down before the vital internal organs stop functioning and death occurs.
The problem with anorexics is that they almost never accept help. Many anorexics deny that they have a problem at all, and so oftentimes getting a diagnosis—getting an anorexic to a medical specialist—can be a difficult, traumatic experience. It’s extremely important that somebody suffering from anorexia is able to be diagnosed and start treatment as soon as possible. Unfortunately by the time a lot of anorexics receive treatment, they are well into their anorexia making it more difficult to deal with. This is why it’s important to know the signs and symptoms of anorexia in order to make an early as possible move for treatment.
Ultimately, though, an anorexic will only be receptive to help once they realize themselves that they are in trouble and need help. The diagnosis of anorexia is done by a medical professional or, if possible, an eating disorder specialist. The anorexic will receive a physical and psychological assessment and his/her social needs will also be examined (do they live alone, do they have family who can assist, etc.). Once this is completed and an account of the damage that has been done already made, then treatment options will be made available.
Treatment for Anorexia
Treatment for anorexia is a two-pronged attack. Often, the first thing to do is to get the patient well again with a supervised weight gain plan to halt the damage that has been done by the starvation of the body. This needs to be done with plenty of family support, as well as professional support. In some cases, hospitalization will be necessary if the body is especially malnourished. From then on it’s a question on working on the causes of anorexia with a trained eating disorder professional who will teach the anorexic how to have a better relationship with food and their body in the future.
Getting cured of anorexia is not at all easy. It’s a question of shifting a whole mindset, a mindset that might have been there for a number of years.
After anorexia, bulimia is the “other” eating disorder that people think about when asked. Bulimia is the act of binge eating and then (often, but not always) purging—making yourself vomit up everything that you’ve just eaten. The main difference between anorexia and bulimia is the fact that anorexics’ signature is that they avoid food at all costs. They are starving themselves. Bulimics are generally at a healthier body weight—often a normal body weight—but yet something inside them compels them to gorge food secretly and then purge it. It’s generally not hunger that causes a bulimic to eat to excess but more often just a complete lack of control caused from any number of psychological conditions from depression to a lack of confidence or self-esteem.
Oftentimes, unlike anorexics, a bulimic will sit and have a proper meal without any worries—as mentioned, they are not starving themselves, at least not in the same way and for the same reasons as an anorexic. But it’s outside of those regular meals where something will drive them to overeat something very fast and then purge themselves afterwards—often feeling shame and guilt for what they have just done.
One way to think about bulimia is that to a bulimic, food is a crutch with which to rely on when needed. To an anorexic food is the enemy. But when a bulimic needs their crutch, they go so overboard that the feelings of despair afterwards force them to get rid of that food inside of them. Most of the time a bulimic will (1) vomit the food back up, but sometimes he or she will (2) use laxatives or (3) exercise to excess or (4) fast for a couple of days in order to make up for the food that they have just gorged.
Gorged is the right word, too. It’s not a question of just grabbing something from the fridge for a bulimic. Sometimes a bulimic, when binging, will consume up to 20,000 calories in one sitting.
As with anorexia, bulimia statistics are dominated by women, although the percentage of men that suffer from it is much higher than the percentage of anorexic men, with 20 percent of bulimic cases being male as opposed to only 5 to 10 percent of male anorexics. Bulimia tends to start at an older age (late teens/early 20s) than anorexia does, too.
The more obvious symptoms and signs of bulimia include:
- Binge eating
- Hiding stashes of food around the house
- Constant complaining about having a sore throat
- Discolored teeth
- Disappearing after eating
- Callouses or marks appearing on backs of hands from forcing down throat to vomit
- Fluctuations in weight (either up or down)
- Constant thirst and dehydration
- Stomach ulcers.
Treatment for Bulimia
Unlike anorexia where there is often an urgent need for physical treatment to save a life, treatment for bulimia is usually less “life and death” and more focused on the psychological than the physical. A bulimic is rarely malnourished and starving, although there may be some physical issues that need attending upon such as hydration and stomach ulcers. A mental health professional who specializes in eating disorders will work with a person with bulimia to help reset the individual’s relationship with food, to try to lessen its importance as an emotional crutch. Many bulimics are prescribed a course of antidepressants in order to help them overcome the urge to binge eat, but counseling really is the key with this sort of condition.
Again, as with anorexia and other eating disorders, a bulimic does need to recognize that he/she has a problem that’s out of his/her control, and that he/she needs help in order to truly begin recovery over the condition.
Binge Eating Disorder
Although lacking the notoriety of anorexia or bulimia, binge eating disorder (BED) is a fully recognized eating disorder in its own right (including, but not limited to, the American Psychiatric Association), and it’s actually the most common eating disorder, affecting more people than any of the others. Like bulimia, binge eating disorder is where food is used as an emotion crutch and overeating to excess is done when control is lost. Unlike bulimia, though, persons suffering from binge eating disorder typically do not try to expel their food after eating it.
Out of the main three eating disorders, binge eating disorder is the most ‘equal opportunities,’ affecting both men and women equally. It also tends to start later in adulthood than anorexia and bulimia, which both typically start during the teenage years. Binge eating disorder usually starts well into one’s 20’s or 30’s. Another notable fact about binge eating disorder is that approximately half of all of persons who meet
the diagnosis suffer, or have suffered in the past from, from depression. Binge eating disorder is also connected to dieting. Oftentimes after dieting, a person will binge eat to “make up” for what they missed before. In the end, the practice of binge eating becomes a viscous circle for those with BED. Someone binge eats to self sooth emotionally and make themselves feel better, only to feel terrible about binge eating after the fact, and so the pattern goes.
Diagnosis of Binge Eating Disorder
Pretty much everybody has overeaten at times, either by accident or for comfort, so there is a difference between an occasional splurge and a real, systemic overeating problem. But almost always, a person with binge eating disorder will display some of the following traits that will separate him or her from someone without BED:
- Binge eating at least twice a week for at least six months
- Steady weight gain
- Overeating to excess—continuing to eat even when feeling full
- Lack of control over eating—being unable to stop
- Eating normally when in company but gorging when alone
- Stockpiling food around the house
- Feeling constantly stressed or on edge but only relieved when eating
- Not enjoying the food while eating it but just continuing to eat it anyway.
Outside of the signs listed above, there are also all the usual health problems associated with obesity like type 2 diabetes, heart disease, high blood pressure, cholesterol and so on. These conditions together with weight gain can cause the binge eater to eat in despair and so continue the downward spiral indefinitely.
Treatment for binge eating is complex. It’s entirely psychological and entirely based on re-teaching the person how to reprogram his or her relationship with food and to get to the bottom of the triggers that cause bouts of binge eating. Therapy is an effective method of treating binge eating, and along with individual counseling with a eating disorder expert, group therapy sessions are also a good idea.
In the end, curing oneself of binge eating behaviors is about finding another more productive way to deal with the tough things in life such as stress and depression. It’s about changing one’s relationship with food so that it is no longer an emotional crutch.
Other Types of Eating Disorders
The three most common eating disorders are anorexia, bulimia, and binge eating disorder, but there are others that may not really be officially recognized as “disorders” recognized by the American Psychiatric Association. The times that we live in mean that we are saturated by TV commercials, shows, billboards, music videos, and movies with an idea that we need to look a certain way. We need to be thin and “look hot.” If don’t meet these expectations, then we are less than. This thinking, in part, has contributed to the three eating disorders described above, and also the explosion or a dieting and weight control industry that has taken over so many of our lives in recent years.
Although dieting is not a disorder per se, it can certainly lead to something more serious and in any case, who is to say that any situation where food is in charge of us rather than we are in charge of food isn’t some sort of problem?
So many of us nowadays struggle with our weight and we are miserable over it. Food should be one of the great pleasures in life and yet even if we are not anorexic, bulimic, or struggling with binge eating, we are still somehow under the thrall of what we are putting into our mouths and we are no longer enjoying that experience of eating. Maybe we eat too little, maybe we eat too much, but either way we feel guilty after a scoop of ice cream. Perhaps it’s time to treat this constant guilt and agony that we put ourselves through as some sort of mild eating disorder in its own right.
Perhaps we all need to reevaluate our relationships with the food that we consume.
Eating Disorders in Popular Culture
Over the years, especially since the 1990’s, anorexia has become something of a “celebrity” condition, with persons in the public eye, especially young women—models, actresses, singers—becoming affected. It goes back to that idea of having the “perfect” thin body. The fact that so many famous people have battled with eating disorders like anorexia is unfortunate, as it runs the risk of normalizing the condition among the vast majority of average, non-famous people and may encourage others to starve themselves to be like their aspirational role models. In recent years, the entertainment
and fashion industry has made moves in combatting anorexia, or at least the image of anorexia. Plus-size models are coming back, and other stars are making big efforts to steer people away from the threat of anorexia.
France, one of the fashion-centers of the world, has recently introduced laws to regulate its fashion industry, requiring models on the catwalk to have a medical certificate saying that they are of a healthy weight. If a fashion photo is photo-shopped to make a model look thinner, French law now requires that the magazine state that fact. Model agencies can be subject to fines and possible imprisonment for hiring models with unhealthy body mass indexes (BMIs). These laws came in after a French model died of anorexia in 2010. In addition, Israel has similar laws regulating the fashion industry, after two models died there in recent years.
Despite these advances, however, there is still a problem in the fashion industry and many fashion models have stories of being “told” to either lose weight or lose their jobs and so on. As of this writing, the United States has not regulated its fashion industry in the way that France and Israel have done.
Actress and model Carre Otis, who worked through the mid-1980’s and 1990’s and is now an ambassador for the National Eating Disorders Association, said of her modeling days:
“Whenever asked about my diet/workout, I would cite a healthy routine, the kind touted in women’s magazines. “Jazzercise three times a week and light weights,” I’d say. The heavily guarded truth was that I exercised a minimum of two hours a day, seven days a week. On days when I wasn’t working, I did double duty, going to the gym twice in one day. I said I ate oatmeal for breakfast, chicken and veggies for lunch, and fish and salad for dinner, along with a healthy snack like yogurt. But in reality, my big diet staple was four to six cups of black coffee per day, avoiding even a splash of skim milk since I was terrified of extra calories. And to stave off hunger, I went through a few packs of cigarettes daily. Cigarettes with coffee gave me an energy boost. And all energy boosts were welcome because my body was perpetually fatigued from little to no sleep, over-exercised muscles, starvation and the relentless stream of criticisms inside my own head.”
Otis has also admitted that the fashion industry is the worst place for someone with an eating disorder to be around, saying:
“Anorexia was there for me before I got into modeling, but because of the arena and the demands, the disease really got out of control for me. It’s like being an alcoholic and going and being a bartender.”
It seems to be inevitable that in an industry that relies on physical perfection, that there will always be issues with eating disorders. Other famous people that have been affected with eating disorders are below, alongside some quotes from them about their struggle where appropriate:
- Karen Carpenter – US singer (died of anorexia in 1982)
- Ana Carolina Reston – Brazilian model (died of anorexia in 2006)
- Isabelle Caro – French model (died of anorexia in 2010)
- Paula Abdul – US singer and American Idol judge (battled bulimia): “It is one of the toughest things to talk about, bar none, and it is one of the hardest disorders to deal with because it’s not black or white. Eating disorders really have nothing to do with food, it’s about feelings.”
- Lily Allen – UK singer (battled bulimia)
- Imogen Bailey – Australian model (anorexia)
- Justine Bateman – US actress (anorexia)
- Victoria Beckham – ex-Spice Girl and fashion designer (binge eater)
- Kate Beckinsale – UK actress (anorexia): “People keep asking me about it but I don’t want to be famous for being a former anorexic.”
- Demi Lovato – US actress/singer (anorexia and bulimia)
- Russell Brand – UK comedian/actor (bulimia)
- Lady Gaga – US singer (anorexia and bulimia)
- Alanis Morisette – Canadian singer (anorexia)
- Jane Fonda – US actress (bulimia)
The above names are just some of the many famous people who have suffered or even died due to eating disorders. Other names include Princess Diana, Oprah Winfrey, Elton John, Kate Winslet, Ashlee Simpson, and Joan Rivers to name but a few. The entertainment and fashion industries are inundated with persons struggling with eating disorders.
There is a saying that goes somewhere along the lines of “you have to either laugh or cry” when speaking of any given subject. The subject of eating disorders is an incredibly heavy one, but there is humor out there too. So along the lines of there being no rules in comedy, here are some of the best jokes about eating disorders—Cos if you ain’t laughing you’re crying, right?
In November 2015, the TV show The View got into a little bit of trouble over making an eating disorder joke.
Cohost Joy Behr said live on air, “We were just discussing whether it’s better to become bulimic or anorexic backstage.” Cohost Michelle Collins replied, “Definitely bulimic. You get to enjoy the meal.”
Boom boom. The view got into trouble for that and was forced to apologize after a number of people called and e-mailed into ABC to complain. Yet compared to other eating disorder jokes, that’s nothing. Here’s some more:
“For as long as I can remember, I’ve had an eating disorder: reverse anorexia. It’s when I look in the mirror and think I’m really skinny.”
“Why do bulimics love KFC? Because it comes with a bucket.”
“I went for a drink with a bulimic girl last night. I was a bit worried about mentioning her illness, but once she had a drink down her she brought it up straight away.”
“I’ve got a new anorexic girlfriend. But it’s not going well. I’m just seeing less and less of her…”
Ouch. Time to stop there before these jokes get seriously offensive. But it goes to show that there is humor in anything and that one can make a joke about anything. Whether one should or not is another matter, but the reality is that many times humor—even a tough joke—can shine light on a serious topic that affects so many people around the country, and the world.
We think that a suitable conclusion to a piece about eating disorders is to really use some uplifting words from someone who has been there, who knows what it’s like to suffer through recovery. Enter Alanis Morisette to have the last word:
“As a teen, I was both anorexic and bulimic. I was a young woman in the public eye, on the receiving end of a lot of attention, and I was trying to protect myself from men who were using their power in ways I was too young to know how to handle. Disappointment, sadness, and pain hit me hard, and I tried to numb those feelings through my relationship with food…I hope my effort shows any woman battling an eating disorder or poor body image that she’s not alone—support is out there—and inspires her to discover her inner athlete. It doesn’t matter what your fitness-skill level is. It’s all about finding the activity you enjoy most and sticking with it.”