Eating Disorders

Anorexia nervosa and bulimia are probably the two most prevalent, severe types of eating disorders.

Anorexia occurs when an individual, usually a female between the ages of 12 and 30, imposes severe caloric intake limitations upon herself. This occurs due to an intense fear of gaining weight and a distorted body image that causes her to view herself as obese. It is one of the few psychiatric disorders with a high mortality rate. The death rate ranges from 5 to 22.5 percent.

Women or girls afflicted with anorexia tend to be highly achievement-oriented. They are usually from a higher socioeconomic status. Often one or another of the parents was exceptionally skinny as an adolescent, or preoccupied with his/her weight. The anorexic kids often have an unrealistic fear of failing or not living up to parental expectations in some way. It is not too difficult to imagine a link between the parent’s weight emphasis and the parental expectations on their children.

Anorexics tend to be preoccupied with thoughts about food. They will often collect recipes, enjoy cooking for others, and hide copious amounts of food about the house. They may also go on eating binges, followed by self-induced vomiting. Most anorexics also abuse laxatives and diuretics.

Denial is a powerful defense mechanism used by anorexics. The greater the degree of denial, the more pathological the body image distortion and the poorer the prognosis for treatment.

We all probably have times when we look into a mirror and focus upon our worst points, be that a bulging abdomen, double chin, or fat rolls in assorted places. Anorexics will tune in on and greatly exaggerate any suggestion of adipose tissue, hence the distorted body image.

Two main theories exist about the causes of anorexia. One theory espouses the belief that anorexia nervosa is a phobic response related to body changes associated with puberty. Amenorrhea, or a cessation of the menstrual cycle, is often one of the first symptoms of anorexia. Moreover, sexual desire is reduced or eliminated by the malnutrition. This could be considered one way of dealing with unacceptable sexual feelings with which the patient cannot cope.

The psychoanalytic theory is very similar. Hard core psychoanalysts feel that anorexics are perhaps rejecting a wish to be pregnant. Anorexics are felt to have bizarre fantasies that somehow they risk becoming pregnant by eating.

Treatment for this condition involves a prolonged hospital stay in which the patient’s physical condition can be monitored and controlled, if necessary by tube feeding. These clients are difficult to work with as they deny problems and often resist any attempt to get them to eat.

My own preferred psychological treatment strategy involves the doctor and the client working together to establish a weight agreeable to both parties. The treatment team carefully monitors caloric intake to make sure that the client does not go beyond certain narrow limits in either direction. This reassures the client that control will be maintained over her weight, hence over her body image and any other relevant real or imagined variables.

Anorexia is a tough disease to treat and I usually refer hard-core cases to treatment centers such as the Renfren Center. I do not know of any good treatment centers for eating disorders in Texas.

Bulimia is an eating disorder found in some obese people. You might say it is a small subset of all obese people. Such individuals, usually in response to some sort of stress, will compulsively eat large quantities of food in a very short time.

Probably another way to describe bulimia might be to call it binge eating. Binge eaters feel very anxious and guilt-ridden about their behavior, even as they are gorging themselves on food, certainly afterwards.

There is actually a great deal of overlap between anorexia nervosa and bulimia. Anorexics will, at times, go on secret binges, following these episodes with self-induced vomiting.

Also, both bulimics and anorexics have a disturbance in body image. People suffering from both disorders are self-conscious and critical of their appearance. Your “normal” jolly fat person actually does not feel all that bad about himself or herself psychologically.