Eating disorders bulimia anorexia nervosa are the two majors, both of these are considered to be forms of mental distress in the individual. Bulimia nervosa was only recognised as an illness 20 years ago. The two conditions are similar and it is common for bulimia nervosa to develop after a short period of anorexia nervosa. At times someone may have the features of both conditions.
The causes and treatment of these conditions may differ. Women are affected by these illnesses ten times more commonly than men are, and so in this page we will refer to the sufferer as ‘she`. Anorexia nervosa is a disorder in which a person starves herself past slimness to the point at which she is so emaciated that her life is put in danger, this needs a Treatment center or specialist to help address. Stringent dieting and fasting are present in bulimia nervosa also but the characteristic symptom of this condition is that episodes of intense cravings for food with secretive, gross overeating (binges) occur. These binges are followed by a “purge” to avoid any weight gain from the food eaten.
The sufferers are so terrified by the idea of gaining weight that they are driven to make themselves sick, fast for several days, exercise excessively or abuse large quantities of laxatives, diuretics or diet pills. Women can be underweight, overweight, or normal weight, depending on the balance of bingeing and weight control methods
It is unusual for the sufferer to be concerned about her health; on the contrary, she will be overactive and study or exercise excessively. This makes it difficult for even family members to realise something is wrong until the disorder is severe. The family may not realise that nutritional intake is inadequate as her meals may consist of large quantities of vegetables or salads. Appetite is not usually lost, rather the opposite, she thinks about food constantly. The sufferer will disguise the extent of her weight loss by wearing voluminous clothing.
Often there is a distorted body image; she remains convinced that she is fat even when it is apparent to every one else that she is not. One clear sign is that her periods will stop. In contrast the sufferer from bulimia nervosa is mortified and worried by her behaviour but is too ashamed to reveal it. She is frightened of the physical damage she is causing herself. Friends and relatives will notice that although the sufferer does not eat with them at mealtimes, or will only eat small amounts of low calorie foods, large quantities of food may be missing from the refrigerator or cupboards. The preoccupation with weight and shape may mean that it takes a long time to choose clothing each day, and dismay caused by her appearance or behaviour will lead to the cancellation of appointments. Evidence of vomiting or purging may be present in the bathroom.
It requires an enormous amount of skill and persuasion to help someone with anorexia nervosa to acknowledge that they have a problem. Early recognition may prevent the development of a severe form of the illness and the need for specialised treatment may thus be averted. If left untreated anorexia or bulimia nervosa begin to dominate the sufferer’s life: she becomes unable to concentrate on anything else. Her character also changes, she may be difficult to get along with and may become deceitful. It is important to remember that young women can die from this illness, and that a quarter of cases have a chronic illness which disrupts their life profoundly and in some cases leads to suicide. Accounts of bulimic behaviour in popular magazines may suggest that it is a magic solution to the difficulties of slimming whereby you can eat your cake and not have to suffer the consequences. This is far from true. Women with bulimia pay a huge toll.
Starvation has physical, psychological and social costs. The whole body pays: sleep is disturbed; cold is intolerable, the heart and circulation is weakened; bones fracture; cholesterol increases; production of red and white blood cells decreases; muscles weaken; hair redistributes; the bowels stagnate; the brain shrinks; concentration and complex thought ceases; misery replaces joy and enthusiasm; social interaction becomes arduous. Methods of weight control also have life-endangering risks and inevitable costs. Vomiting dissolves away teeth, damages the gullet and leaches from the body the salts, which are vital for heart, muscle and kidney function. Laxatives destroy bowel muscles and drain away salt and water. Other medications taken to aid weight loss increase irritability and nervousness. The body will fight back. It will crave for missing nutrients, it will only feel satisfied when the stomach is almost bursting, the salivary glands will swell (fattening the face) and it will suck up salt and water (leading to a puffy face, stomach and ankles).
Three out of every hundred women have a severe form of bulimia nervosa in their lifetime. Milder forms of the illness are common and merge into the cultural variation in diets or food fads. Anorexia nervosa is less common, affecting 7 in a thousand 15-year-old schoolgirls (an age of greatest risk) and 3 in a thousand of all women. Milder forms of the illness are more frequent.
Anorexia nervosa is an illness that has probably afflicted women over the centuries. One explanation of this is that some people have a constitution, which puts them at risk of developing anorexia nervosa. This is manifested by the inability to terminate a diet or to regain appetite after an illness or major loss. Those people who are at most risk are perfectionists who conscientiously plan and order their life. Food and eating may be the one area, which can be successfully controlled and not subject to the whims of fate.
Eating disorders may be a way of coping with problems in life: a way of avoiding issues or emotions, which seems too painful. Common, but mistaken, beliefs are that families cause anorexia nervosa, or that the problem is merely that of “naughty” girl behaving wilfully or stubbornly. Once the disorder becomes established a vicious circle develops. In the initial stages she may be complimented on her slim appearance and commended for her self-control, which may well encourage her. Eventually, the stomach shrinks and empties slowly so that bloating and discomfort makes eating difficult.
Depression and lack of social contact isolates the sufferer from any influence, which could shift the preoccupation with food and eating. In contrast to anorexia nervosa, bulimia nervosa is probably a new form of illness, which has increased markedly over the last two decades in the West. Changes in our culture and environment may account for this. Feminists have argued that the changing roles and expectations of women are the noxious factors in western societies. An alternative explanation is that the modern fashion for leanness, with the accompanying increase in dieting, is to blame. Dieting increases the risk of developing bulimia nervosa 8-fold and the illness is more common among those whose careers require a trim figure. An individual is more at risk if, in addition, she has had a disturbed background or been exposed to untoward events.
The first and perhaps most difficult step in treatment is to acknowledge that there is a problem with eating. Families and friends need to be knowledgeable, patient and yet firm. The next step is to visit the family doctor who will be able to confirm the diagnosis and assess the severity of the condition. The general practitioner will be able to give advice on a sensible diet and monitor weight.
Some people find that they obtain benefit from joining a self-help group. The Eating Disorders Association has a register of self-help groups throughout the country. The general practitioner may decide that specialised help is required and he will refer the sufferer to a specialist, usually a psychiatrist. The specialist will need to gather information (some of which may be sensitive and personal) so that he or she can understand how the food problem developed, what complications are present and what are the factors which make change difficult. He or she may be interested in the information that relatives and friends can provide upon these issues. Special investigations such as a blood test, ultrasound or bone density estimation may be required to complete the assessment.
The major focus of treatment for anorexia nervosa is weight gain in conjunction with some form of “talking therapy” to help the sufferer to come to terms with problems she may be avoiding. In most cases the education and help required to undertake this could be given as an outpatient either to the sufferer alone or with members of the family. Severe forms of anorexia nervosa, which put the sufferer’s life and health at risk, may need to be treated in hospital.
Skilled nursing is the most important aspect of this treatment, but other professionals – psychologists, occupational therapists and dieticians – will also contribute to the understanding of the problem and help to find ways of solving it. It is unusual for medications to play a major part in treatment for anorexia nervosa, although antidepressants and tranquilliser are occasionally needed. Treatment and recovery is usually a slow process: do not expect immediate results. It may also be an emotionally painful time for the sufferer.
Treatment of bulimia nervosa is aimed at restoring a normal pattern of eating, that is three meals a day, without dieting or using drastic weight control measures, while also helping the sufferer to learn to express her emotions and cope with stress in a less destructive way. Sufferers may find it difficult to believe that treatment will not lead to weight gain. Education about nutrition and the controls over food consumption and weight is an important component of treatment.
Treatment may be given individually or in a group format. Recording the pattern of eating in the form of a diary is helpful. The therapist will try to help the sufferer understand why weight control is so important, and will explore factors in the past or present which may contribute, using a form of psychotherapy. If the illness has been severe and prolonged the normal controls over eating will have been disrupted and it willtake time for these to return to normal. Medication may be used to supplement treatment in such cases.
Antidepressant treatment can also be helpful, but on its own is less effective than with psychological treatment. Even after recovery, eating remains an Achilles heel and further relapses may follow stress.
The primary aim of research at the Institute of Psychiatry is to build a causal model which spans both biology and psychology, with the ultimate aim of providing new treatments for these disorders.
Research Into Treatment (RIED) is the initiative of Nina Jackson and a vehicle for raising funds to research eating disorders at the Research Unit, Institute of Psychiatry, via The Psychiatry Research Trust. Despite becoming more and more to the forefront of the public eye, there is still too often an attitude that these conditions are more to do with the attention seeking needs of privileged young girls than serious life threatening illnesses. Currently there are no drugs to help the sufferer as there are for many other psychological illnesses, and the treatment for re-feeding and recovery is very long term.