Health Management Institute
|The Growing Problems of Eating Disorders|
by Lynda Brogdon, Ph.D.
Eating disorders negatively affect the lives of hundreds of thousands of Americans. Anorexia Nervosa, Bulimia Nervosa and Compulsive Overeating are becoming increasingly prevalent in our society. These unhealthy patterns of eating behaviors each have specific characteristics:
Anorexia Nervosa: Intense fear of gaining weight or becoming fat, even though underweight. Refusal to maintain body weight over minimal levels. Severe limitations of food intake. Disturbance in the way in which body, size or shape is perceived. For example, the person feels "fat" even when emaciated. Excessive exercising in order to lose weight. In women, an absence of at least three consecutive menstrual periods.
Bulimia Nervosa: Recurring episodes of binge eating, rapid consumption of a large amount of food in a short period of time. Regularly engaging in purging (getting rid of food through self-induced vomiting). Excessive use of laxatives, diuretics, strict dieting, fasting or vigorous exercise to prevent weight gain. Feeling out of control during the eating binges. Persistent over concern with body shape and weight.
Compulsive Overeating: Binge eating without purging through vomiting or laxative use. Eating for reasons other than hunger. Being unable to stop eating. Feeling guilty about eating. Constant preoccupation with food and diets.
There is no one specific etiological cause of eating disorders. However, biological, familial, social and cultural factors all play a part in their development. Decades of social and cultural pressure for women to conform to thin standards, associated with physical attractiveness and the current diet "industry", have created an ideal climate for eating disorders. Also, the social and biological pressures of adolescence can often trigger eating disorders in young women. The need for acceptance and approval is often perceived to be correlated with appearance, i.e., beauty, body size and body shape. Family communication patterns and attitudes toward food and fat play an important role. A persistent desire for emotional connection and acceptance by parents are experienced by all children. When this need is unfulfilled, feelings of self doubt and anxiety are often experienced. Although the problem may have been existing for a long time, sometimes major disappointments or rejection triggers an eating disorder or exacerbates eating disorder symptomology (bingeing & purging). Body chemistry can be a factor in some cases. The role of depression in eating disorders has been observed with relative frequency. For example, specific neuro-transmitters, which regulate mood response, frequently become unbalanced in persons with eating disorders. Other body chemicals that affect hunger initiation and inhibition may also be found out of balance.
Anorexia commonly begins in the teens, but can start at any age. The incidence of anorexia among 8-11 year olds is increasing. Most individual and family therapists agree that anorexia can represent an adolescent's struggle for independence. This can present difficulties in families in which parents feel a need for control or are uncomfortable about "letting go" of their child.
Bulimia tends to develop during the teen years or early 20's, but the onset may also be younger. Many bulimics are able to hide their symptoms because they appear healthy and successful and are frequently "perfectionists." However, they often suffer from low self-esteem and depression and may exhibit other compulsive behaviors or addictions. The extreme purging behaviors of bulimia upset the balance of body chemicals and can damage organs as well. Compulsive overeating can create the health hazards associated with obesity.
Eating disorders nearly always have more to do with feelings than with food. Food is often used as an attempt to mask emotions, particularly if those emotions are negative or painful. Insensitivity to interoceptive cues, or the inability to identify or articulate internal states such as hunger and safety, is a common characteristic for many persons with eating disorders. Another example of this disturbance is evidenced by the lack of response to cold, fatigue, and sexual feeling in persons with anorexia. Recognition of other feelings such as anger and sadness are also difficult for these individuals.
Most people find it difficult to stop anorexic, bulimic or compulsive overeating behavior without professional help. Left untreated, these disorders can lead to several health problems, even death. Psychotherapy by professionals and at times, appropriate pharmacology, can be effective tools in facilitating recovery.
Treatment for eating disorders is both complex and multi-dimensional. Depending on the severity of the disorder and if the patient is at risk, inpatient treatment may be needed. However, if the patient is physiologically stable, a comprehensive outpatient treatment program can provide effective care more cost efficiently.
Outpatient care frequently incorporates treatment components that have been found to be successful in inpatient and outpatient settings. For example, comprehensive psycho-education is an essential component. This facilitates an individual's combatant of denial and assists them in identifying and understanding issues that may have contributed to the development of their eating disorder.
The utilization of experiential therapy approaches, such as music, art and movement therapy, psychodrama, guided imagery and family reconstruction is particularly applicable for this population due to the nature of their problem. First, the disorders have a physical and somatic component that is accompanied by a disturbed body image. Secondly, many eating disordered patients are unaware of their internal affective and cognitive experiences. Successful treatment includes helping individuals become aware of, understand, and accept their inner thoughts and feelings. Thirdly, eating disordered individuals are often reluctant to disclose their true selves. This may be due to a lack of personal definition of self or a hesitance due to feelings of shame and inadequacy, and fear of rejection. In summary, expressive therapies are helpful in uncovering feelings and recollections of bodily experiences since their symbolic nature obscures meaning, while permitting uninhibited expression.
The establishment of a normal, healthy eating pattern is a primary goal of effective treatment. Often persons with eating disorders have eaten inappropriately for such a long period of time they have difficulty conceptualizing what "normal" is. Exercise is also part of a healthy lifestyle. The development of an activity plan by an exercise physiologist that provides an appropriate level of energy expenditure is an important element of therapy.
Important clinical issues are also addressed throughout therapy. These issues include autonomy, identity, self-esteem, assertiveness, impulse regulation, affect modulation, body image and interpersonal relationships. Concerns of this nature are addressed in individual and group therapy.