Eating Disorders- Anorexia Bulimia Bingeing
Eating disorders are actually a very complex problem, but are viewed by a large percentage of the population as simplistic - from the point of view that the sufferer must have a problem with food – either they want to be slim, so consequently don’t eat much food, or must very greedy, so eat lots of food. That view however could not be further from the truth. Eating disorders are invariably a symptom of internal issues, which I will highlight later.
This section will discuss problems pertaining to anorexia nervosa, bulimia nervosa, binge eating disorder and compulsive eating, but the therapy I undertake may well suit the variations of these problems.
Anorexia
Anorexia nervosa may be considered akin to Bulimia in certain areas, but quite separate in the consumption food and the ‘rigid’ type of thought processes. The way Anorexia is normally diagnosed is the following:
- A grim determination to control body weight under what would be considered normal for the person’s age and height. This loss in weight would need to be considered less than 85% of expected weight.
- An extreme paranoia / fear of putting on weight and / or the thought of putting on fat even though may be considerably underweight.
- A distorted view of own size / shape / body weight
- Amenorrhoea (no ‘period’ ) [female sufferers] having missed at least 3 menstrual cycles
Anorexia – Who
The occurrence of Anorexia in females is thought to be around 5%. In males this appears to be on the increase. In the 1980’s it was estimated that for every 15 women with Anorexia or Bulimia there was one man. Today researchers find that for every four females with Anorexia, there is one male.
Eating disorders can affect literally ANYBODY. Those with Anorexia are typically pretty, impressionable, thoughtful and agreeable bright youthful females usually from the ages of 12 to around 25 years old, but of course there can be there a significant variations in age. Usually, having been ‘nice children’ – often devoted and seeking to help.
They like approval and ‘taking care’ of people. However, they are usually perfectionists and like to be in control, everything is black or white, good or bad. If they are not perfect then they MUST be a failure. They think thin - and thinnest is best (perfection again). Invariably it is a way of controlling there lives, because they have (often) had turmoil in their life, family upsets, bereavements, relationship problems and other issues in which they have felt powerless to control, so frequently the one thing they can control is food. They have set ways in doing things and consequently inflexible ways of thinking and doing things. There is also a fear of growing up and often are ‘clingy’ to their parents, usually coming from ‘respectable’ homes or wealthy families and frequently wanting to stay at home. They can have feelings of insecurity and that they ‘don’t fit in’ with friends / social circles. As well as the rigid eating style there is often the same rigid adherence to exercise. Clearly these are principal symptoms and they may vary in degree and severity, some may have other symptoms too like depression. It is also a distressing fact that many do not seek help until their symptoms become life threatening.
Indications of Anorexia:
- Always feeling cold
- Extreme exercise
- Disrupted or loss of menstrual cycle
- Irregular heart beat
- Low pulse rate and / or blood pressure
- Constantly weighing self with ‘over the top’ reaction to any perceived weight gain
- Lowered sex drive
- Dry skin
- Rigid lifestyle
- Wasting of muscles
- Perfectionism
- Potential risk of osteoporosis
- Risk of organ failure
- Imbalance of Sodium, potassium, Calcium & Bicarbonates.
- A dread of becoming fat
- Loss or thinning of hair
- ‘Downy’ hair on arms / legs
- Swelling to the hands
- Decrease in Thyroid function
- Distorted view of own body image
- Constipation
- White blood cells reduce
- Inflexible eating habits and adherence to an extreme low calorie diet
- Wearing baggy clothes to hide thin body
- Feelings ranging from Euphoria to feeling disorientated
Bulimia Nervosa
This is a diet – binge – purge disorder and like Anorexia can kill. The sufferer puts on a courageous effort to be ‘normal’ but often experience depression, loneliness, inner anger, self doubt and feel ashamed / guilty when they are by themselves and are unable to talk about their feelings. They can be promiscuous, take illicit substances, binge drink and become reckless with shoplifting, often from food stores.
Their friends often say they are fun to be with, and would never assume there was anything wrong with them. They have distorted body image and obsessed with their body weight, frequently having a history of failed diets.
The difference between them is that while Anorexics feel better when they don’t eat, Bulimics are confronted every day with their explanation of their failure to control themselves and their food intake. As mentioned above, they gain a sense of control by using diuretics, enemas, suppositories, laxatives, forcibly vomiting with their fingers or taking emetic agent, so they feel more in control, as the excessive amount of food eaten can be got rid of. The other important factor is they do not show other people (especially parents), work colleagues, that they are losing weight or look anorexic in appearance.
Body weight may vary from normal to mild, moderate, or severe obesity. This of course keeps everyone happy, which is what the Bulimic is attempting to achieve. The only person that may be aware is the Dentist as their tooth enamel deteriorates, or a Doctor who finds a biochemical imbalance, for example low potassium, magnesium and sodium levels. There is a possibility of losing substantial weight, however, they regain this without any medical intervention.
Persons in the Bulimic category are more likely to accept elimination of Binge Eating as a primary goal. They can consume vast quantities of food, usually carbohydrates very rapidly, fast for days then have another binge.
Often when emotional problems are resolved and better coping skills and strategies are employed the outcome of therapy is generally good in most clients.
Simple Bulimia most commonly seems to occur when females are about 18 years of age. They have usually been slightly under confident and unassertive, although fairly popular. The illness is frequently started by a period of unhappiness or depression and this can be caused by a destructive relationship with a boyfriend. The feelings of self dislike focuses on appearance, so they begin to diet to improve self-esteem and confidence.
In comparison to an Anorexic, the diet is not very successful, with the rigid control needed in breaking down into spells of cheating. Vomiting is employed to achieve the weight loss and so the cycle of bingeing and vomiting begins. There is more loss of control as the body’s normal mechanisms of appetite control are over ridden and confused. The weight will remain near to normal but the eating regime becomes gradually poor.
This form of Bulimia is the least severe but does vary considerably in intensity. There are probably many females with reasonably mild symptoms who never seek help, but there is a significant risk that it will slowly get worse with time. A frequent time for those with mild Bulimia to seek help is when they are planning to start a family in their early twenties and are concerned about possible effects of conceiving or having children. Often when emotional problems are resolved and better coping skills are employed, the outcome of therapy is generally good.
Bulimia Overview
- Possible recklessness
- Possible shoplifting (food stores)
- Guilt & low self esteem
- Obsessed with weight
- Many are normal within weight parameters
- Large weight increase and / or loss
- Depression / suicide
- Tooth enamel deteriorates
- Rupture of the Oesophagus
- Inner anger
- Eating huge amounts of food in a short time
- Gastric rupture
- Binge eating in secret
- Ulcers & pancreatitis
- Distorted body image
- Constipation
- Gastric ulcers
- Perfectionist
The diagnostic criteria for Bulimia are as follows:
- Recurrent episodes of Binge Eating (which is characterised by a sense of lack of control over eating large amounts of food in a discrete time period)
- Recurrent, inappropriate compensatory behaviour in order to prevent weight gain, eg. Vomiting, abuse of laxatives, diuretics or other medications, fasting or excessive exercise.
- A minimum average of two episodes of binge eating and inappropriate compensatory behaviours per week for the past three months. Self evaluation unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during episodes of Anorexia Nervosa. Bulimia nervosa clients are further subdivided into purging type and non-purging type, based on the regular use of self induced vomiting, laxatives, diuretics or other medications, fasting or excessive exercise.
Binge Eating Disorder (B.E.D.) is an ailment with a distinct difference from Bulimia in that the sufferer does not purge their body of the food through vomiting, laxative abuse or over exercise. Therefore, they often eat abnormal amounts of food in a very short period of time, usually less than 2 hours. They eat so rapidly and swallow without chewing, and often for a long time, with a distinct lack of control over eating, usually secretly, tending to hide food as well. They eat for emotional reasons to avoid anxiety-provoking situations, reduce emotional pain and comfort themselves.
Eating at night or eating when they are not hungry frequently causes them to feel disgusted with themselves afterwards, as they attempt to cope with stress, anxiety, and unhappiness and then add to the disappointment with themselves about bingeing. Most are depressed and have anxiety states. They can eat such great quantities of food, manifesting in discomfort and pain. This in time causes obesity and a possibility of diabetes, hypertension, high cholesterol and many other complications.
Research suggests that around 60% of American adults are overweight, 34% are obese which means they are 20% or more above an average healthy weight. Many of these are binge eaters. Not included in this, is that 31% of American teenage girls and 28% of teenage boys are overweight, and 15% of girls are obese along with 14% of boys. (Stats 2004). Some of the possible causes are fast food, high sugar content snacks, use of automobiles; longer periods spent watching tv, video games and computers. A reported study shows 1% of females in the USA have a binge eating disorder and 30% of females seek treatment to lose weight.
Symptoms
- Social isolation
- Need to be in control
- Eating huge amounts – usually alone
- Eating large quantities when not hungry
- Vascular disorders
- Depression
- Obstructive sleep apnoea
- Hypertension
- Gall bladder disease
- Stroke
- Diabetes
- Heart disease
- High cholesterol levels
- Musculo-skeletal problems
- Thrombosis
Compulsive Overeating
Attempting to cope with stress, anxiety, depression, low confidence or self-esteem, emotional conflicts, Compulsive Eating can become a detrimental problem to their health, becoming overweight. They often deny or recognise that there is a problem. Compulsive overeating can begin in early childhood when eating patterns are formed.
Most people who become Compulsive Eaters are those who never learned the proper way to deal with stressful situations and used food instead as a way of coping. Unlike Anorexia and Bulimia, there are a high proportion of excessive eaters. Over time, if this continues, can become morbid obesity where gastric banding or stapling would be necessary for survival. Obviously other factors need to be eradicated first, such as thyroid functioning.
They frequently withdraw from activities because of embarrassment about weight and many have tried so many different diets and feel tormented by these over eating habits where the main focus of life is on weight. They always think about food and often have secret hoards of food, becoming anxious when eating, and believing that hunger makes them feel uneasy or vulnerable. They then compulsively eat, which reduces their negative thought processes, then feel bad or guilty about over eating, and the whole process starts over again.
By significantly reducing their stressors, anxiety, depression or other underlying fears or concerns, enables them to cope easier with life.
Compulsive Eating Overview
- Depression
- Social isolation
- Need to be in control
- Eating huge amounts, usually alone
- Eating large quantities when not hungry
- Vascular disorders
- Obstructive sleep apnoea
- Hypertension
- Gall bladder diseases
- Stroke
- Diabetes
- Heart disease
- High cholesterol levels
- Musculo-skeletal problems
- Thrombosis
Conclusion. As with much of the therapy I undertake, those with eating disorders frequently do not seek help. Therefore, to bring about relief successfully the client needs to understand that therapy is a 50/50 involvement between client and therapist. This may seem an obvious statement, but until the person WANTS to recover, and has the mental resolve to WANT to recover, then resolution is often difficult. I will discuss all these aspects with you during consultation.