Eating Disorders

wpe2.jpg (4082 bytes)

The In's and Out's of

Eating Disorders

In North America many youths, especially women, indicate that they are unhappy with their weight. In fact, more than 40 percent of high school women report that they are dieting (Centers for Disease Control, 1991). Concern about weight seems especially prevalent in Caucasian and Hispanic youth, less so for African American young women. A substantial number of teenagers, especially girls, many who are not obese, go to great and even life-threatening lengths to reduce their weight. Thus, eating disorders are the extreme result of weight dissatisfaction and dieting.⁽¹⁾A distorted body image is perceived and the individual suffers from low self esteem. These disorders include anorexia nervosa, bulimia and compulsive eating disorder.

Contents

Quick Facts

Eating Disorders: Similarities and Differences

Common Thoughts and Feelings

Warning Signs for AN and BN

Common Characteristics of Anorexia Nervosa & Bulimia

Anorexia Nervosa

Bulimia

Compulsive Eating Disorder

Where To Find Help

References

Quick Facts

most common onset is between 14 and 25
in the 14-25 age group: 1-2% suffer from Anorexia; 3-5% suffer from Bulimia
in Canada 200,000-300,000 females between 13 and 40 have anorexia, two times this amount have bulimia
90% of females experience dissatisfaction with body image
80% of females have tried at least one diet by the age of 18
about 35% of eating disorder cases receive a personality disorder diagnosis
obsessive compulsive features are fairly common in anorexia
anxiety associated more frequently with bulimia; anorexia related to fear of weight gain
depression is associated with bulimia, anorexia, compulsive overeating and severe obesity
as many as 1/2 of the deaths of anorexics will be suicide
anorexia and bulimia are highly culturally specific - only in Western culture where food is plentiful
90% of cases of severe eating disorders are young, white females of upper socioeconomic status
5-10% of the male population suffers from an eating disorder
5-20% end fatally

Eating Disorders: Similarities and Differences

(Williamson, 1990)

Problem Area	Obese	Compulsive Overeater	Anorexia Nervosa	Bulimia
Typical weight level	20% or more above normal weight	Normal weight to obese	15% or more below normal weight	Normal to 10% above or below normal weight
Binge eating	Occasional	Frequent	Episodic	Frequent
Preferred weight control method	Frequent restrictive diets	Frequent restrictive diets	Severe fasting	Purging
Body image distortion	No	No	Yes	Yes
Forbidden foods	Not applicable	Binge on them	Avoid them	Binge on them, if purging is possible
Anxiety after eating	No	No	Yes	Yes
Influences of mood on binges	Yes	Yes	Yes	Yes
Presence of secondary psychopathology	Normal to moderate	Moderate	Severe	Moderate to severe

Common Thoughts and Feelings

Control - Strong need to control your body shape, size, and eating behaviour. Unfortunately, you don't have control, the eating disorder has you in its control.

Fear - Constant concern with daily weight and the possibility of gaining weight. Acceptance of a healthy body weight can overcome this fear.

Anger - Angry with your body shape and size and/or eating habits. You must think about why you are dissatisfied with your body size and the feelings behind your eating habits.

Poor Self-esteem - Feelings of insecurity and helplessness when dealing with others. Feeling that control over weight and eating habits will reduce negative feelings. It is important to realize an eating disorder does not resolve emotional concerns.

Perfectionism - Feeling that anything less than excellence means failure. In reality, you will not be able to achieve a weight goal that is acceptable to you as it constantly changes.

Warning Signs for Anorexia Nervosa and Bulimia

Warning Signs for Anorexia	Warning Signs for Bulimia
Dramatic loss in weight	A noticeable weight loss or gain
A preoccupation with food, calories, and weight	Excessive concern about weight
Wearing baggy or layered clothing	Bathroom visits after meals
Relentless, excessive exercise	Depressive moods
Mood swings	Strict dieting followed by eating binges
Avoiding food-related social activities	Increasing criticism of one's body

Common Characteristics of

Anorexia Nervosa & Bulimia

	1. Perfectionism
	2. Compulsive exercise
	3. Social isolation and withdrawal
	4. Difficulty adapting to change
	5. Irritability; moodiness; depression (can be a suicidal risk)
	6. Frequent weighing and/or measuring
	7. Hoarding of food
	8. Inflexible in their behaviors
	9. Tendency to think in extremes, i.e., "If I'm not thin, I'll become obese."

Anorexia Nervosa - a kind of self-imposed starvation most frequently found in Caucasian, middle- to upper-income young women. Anorexics appear to be obsessed with the avoidance of appearing too heavy and as a consequence become dangerously thin.

rare to begin after 25
effects 1 out of every 1000 people aged 13-25 in North America
peak incidence 1 out of every 200 females between 15-18
5-21% of anorexia victims die
50% adopt purgative and starvation methods of weight control
resting metabolism rate lowered an average of 24%
1 in 20 anorexics is male


Signs & Symptoms	Consequences
Significant weight loss Loss of menstruation Refusal to maintain a healthy weight Fear of becoming fat Vigorous exercise to prevent weight gain Sleep disturbances Skin abnormalities: yellowish skin or dry, pale complexion, lanugo Thin, brittle hair and nails Hypothermia - lowered body temperature Dizziness; fainting Preoccupation with food & unusual eating habits; extreme control over food intake, i.e., sameness, only diet foods, rituals, etc. Reports eating a lot, but continues to lose weight Intense, irrational fear of fat & weight gain Low self esteem. Thinness is the only source of self esteem Distorted body image Denial and deception Amenorrhea Constipation Abdominal pain Cold intolerance Lethargy Anxious energy Fatigue and headaches Hypertension Bradycardia Edema Inanition	Lowered heart rate and blood pressure Bowel inefficiency Electrolyte imbalance Degenerated muscle tissue Bone marrow changes Cardiac stress Arrhythmia

Bulimia - individual engages in recurrent bouts of binge eating, consuming enormous quantities of food, alternating with self-induced vomiting obsession for thinness through self- starvation ⁽³⁾. Although sharing with anorexics an intense concern about weight, bulimics often fall within a normal weight range for their age and height.

resting metabolism rate 13% lower
"high risk" bulimics view themselves at 115% their actual body size, chose ideal size of 83% actual body size; "low risk" bulimics viewed themselves 100% actual body size, chose ideal size of 95% actual body size
95% of bulimics overestimated body size compared to 48% anorexics
77% of bulimics have at least mild depression
1 in 10 bulimics is male
2/3 of females have experimented with binge eating


Signs & Symptoms	Consequences
Fluctuations in weight Menstrual irregularities Fatigue Sleep disturbances Skin abnormalities: dermatitis around mouth, pasty complexion Binge eating followed by self-induced vomiting Feelings of poor self control during binge and overwhelming guilt following binge eating Bloodshot eyes, dark circles under eyes Swollen glands and puffy face May vascillate between periods of controlled dieting and binge-eating Eats excessive amounts of food, but with no weight gain Fear of fat Low self esteem - shame & self-loathing over bingeing and purging Body image disparagement More likely to admit that food & weight issues are a problem Disappearing after meals; evidence of vomiting or laxative abuse Abdominal pain Lethargy Fatigue and headaches Depression Swelling of hands/feet Parotid gland enlargement	Muscle weakness and spasms Seizures Fatigue Gastro-intestinal disturbances Dehydration Electrolyte imbalance Dental decay, loss of tooth enamel Burning in esophagus Bloating, abdominal cramps, constipation Kidney damage

Compulsive Eating Disorder - uncontrolled chronic episodes of overeating ^(3).

20-40% of obese patients have significant problems with compulsive binge eating


Signs & Symptoms	Consequences
Excessive overeating No self-induced vomiting Overweight Feelings of poor self-control during excessive eating Feelings of fatigue Overwhelming feeling of defeat	High blood pressure Risk of diabetes Risk of cardiovascular disease

A substantial increase in these disorders has been reported since the 1970's and their frequency may be greater in certain groups, who are especially concerned about their weight or physical appearance (Phelps & Bajorek, 1991; Taub & Blinde, 1992). Eating disorders could begin as part of the larger spectrum of anxieties adolescents and young adults experience about physical changes during puberty (Lask & Bryant-Waugh, 1991). Cultural ideals of physical attractiveness, insecurities about family and friends, the hormonal or physiological changes that may be occurring, and concerns about puberty may interact. Thus, sociocultural, psychological, and biological factors may be contributing factors, but the treatments most effective for dealing with such disorders have not been determined. Nevertheless, individuals experiencing eating disorders should be strongly advised to seek professional help.

Where To Find Help

	1. Talk to your doctor / therapist / dietitian
	2. Call the Eating Disorder Hotline of London, Ontario (519) 685-8343
	3. Confide in a trusting friend

REFERENCES

Centers for Disease Control (1991). Body-weight perceptions and selected weight-management goals and practices of high school students - United States, 1990. Morbidity and Mortality Weekly Report, 40, 741-750.

Lask, B., & Bryant-Waugh, R. (1991). Early-onset anorexia nervosa and related eating disorders. Journal of Child Psychology and Psychiatry, 33, 281-300.

Phelps, L., & Bajorek, E. (1991). Eating disorders of the adolescent: Current issues in etiology, assessment, and treatment. School Psychology Review, 1991, 9-22.

Taub, D. E., & Blinde, E. M. (1992). Eating disorders among adolescent female athletes: Influence of athletic participation and sport team membership. Adolescence, 27, 833-848.

Williamson, D. A., (1990). Assessment of Eating Disorders: Obesity, Anorexia, and Bulimia Nervosa, Pergamon Press, New York.