Eating Disorders
Extracted from www.kidshealth.org

Hayle used to love going to the food court with her friends, but now just the thought of it fills her with dread. Besides, she doesn't really even have time to hang with her friends anymore — she needs more time for her running and cardio. It feels like every time she looks in the mirror she looks fat, although the scale says she's losing weight. Hayley doesn't feel like herself anymore. She's having a hard time concentrating in school and she's always so tired.

Hayley has an eating disorder. Eating disorders are common in America — between 5 and 10 million people have them, and experts estimate that 1% of American teens have an eating disorder. That means if your class has 400 students, probably about four of them have this condition.

Other Links
on this page

Anorexia Nervosa and Bulimia Nervosa

What Causes Anorexia and Bulimia?

Sports and Eating Disorders

Effects of Eating Disorders

Treatment for Eating Disorders

Self-Evaluation Quiz

Resources

Anorexia Nervosa and Bulimia Nervosa

The two most common types of eating disorders are anorexia nervosa and bulimia nervosa, more commonly known as anorexia and bulimia. The two disorders can be difficult to distinguish from each other because they have similar characteristics: With both anorexia and bulimia, the person will have a distorted image of his or her body. That person will seem to be obsessed with what he or she eats.

Both anorexia and bulimia tend to affect girls more than guys, but 10% of the people with eating disorders are guys. And, because we typically think of eating disorders as only affecting girls, they often go unrecognized in guys. Guys with eating disorders also tend to focus more on athletic appearance or success than on just looking thin.

People with anorexia have an intense fear of being fat. When a person has anorexia, he or she hardly eats at all — and the small amount of food that is eaten becomes an obsession. A person with anorexia may weigh food before eating it or compulsively count the calories of everything. It is not unusual for a person with anorexia to also exercise excessively in an attempt to lose weight.

A unique feature of anorexia is not only the strong desire to be very thin, but also the altered body perception that goes with it. Even though they might be shedding pounds at a dangerous rate, people with anorexia don't see themselves as thin. A person with the condition can look in the mirror and actually see a fat person.
Bulimia is a bit different from anorexia because the person with bulimia doesn't avoid eating. Instead, he or she eats a large amount of food then gets rid of it quickly by vomiting or taking laxatives. This is commonly known as "binge and purge" behavior. Like anorexia, bulimia tends to affect girls and young women more than guys. Unlike anorexia, you can't always tell by looking whether a person has bulimia. In fact, someone with bulimia may appear average or even above average in weight.

Warning Signs

So how can you tell if a person has anorexia or bulimia? You can't only tell by looking, of course — someone who loses a lot of weight may have another health condition. But if you know of someone who fits the patterns described below, you may want to try to help your friend.

Anorexia:

Bulimia:

What Causes Anorexia and Bulimia?

No one is really sure what causes eating disorders, although there are many theories as to why people develop them. Most people who develop an eating disorder are between the ages of 14 and 18 (although they can develop even earlier in some people). At this time in their lives, many teens don't feel as though they have much control over anything. The physical and emotional changes that go along with puberty can make it easy for even the most confident person to feel a bit out of control. By controlling their own bodies, people with eating disorders feel as though they can regain some control — even if it is done in an unhealthy way.

For girls, even though it's completely normal (and necessary) to gain some additional body fat during puberty, some respond to this change by becoming very fearful of their new weight and feel compelled to get rid of it any way they can. It's easy to see why people may develop a fear of any weight gain, even if it's healthy and temporary: We're overloaded by images of thin celebrities — people who often weigh far less than their healthy weight. When you combine the pressure to be like these role models with a changing body, it's not hard to see why some teens develop a distorted body image.

Some individuals who develop eating disorders can also be depressed or anxious. Experts also think that some people with eating disorders may have obsessive-compulsive disorder (OCD). Their anorexia or bulimia gives them a way to handle the stresses and anxieties of being a teen and allows them to have control and impose order in their lives.

There is also evidence that eating disorders may run in families. Our parents influence our values and priorities, of course, including those toward food — which may be one reason eating disorders seem to run in families. But there also is a suggestion that there may be a genetic component to certain behaviors, and eating disorders could be one such behavior.

Sports and Eating Disorders

Some girls might be more apt to develop an eating disorder depending on the sport they choose. Gymnasts, ice-skaters, and ballerinas often operate in a culture where weight loss is important, and even runners might be encouraged to go on a diet. But in an effort to make their bodies perfect and please those around them, these athletes can end up with eating disorders.

Though it's unusual for guys to have anorexia or bulimia, it can occur, especially with the demands of certain sports. A sport like wrestling, for example, has specific weight categories that can lead some guys to develop an eating disorder. In some cases, eating disorders in male athletes are even unintentionally encouraged; they are taught that winning is the most important thing.

But the truth is that an eating disorder does much more harm than good. Athletes with eating disorders, whether girls or boys, may find that because of a lack of energy and nutrients, their athletic performance deteriorates and they become injured more often.

Effects of Eating Disorders

Whatever the cause of an eating disorder, the effects can be damaging — if not downright devastating and life threatening. People who weigh at least 15% less than the normal weight for their height may not have enough body fat to keep their organs and other body parts healthy.

A person with anorexia can do damage to the heart, liver, and kidneys by not eating enough. The body slows everything down as if it were starving, causing a drop in blood pressure, pulse, and breathing rate. (For girls, this starvation mode may mean they stop getting their periods.) Lack of energy can lead people with anorexia to feel light-headed and unable to concentrate. Anemia (lack of red blood cells) and swollen joints are common in people with anorexia, as are brittle bones. Anorexia can cause a person's hair to fall out, fingernails to break off, and a soft hair called lanugo to grow all over the skin. In severe cases, eating disorders can lead to severe malnutrition and even death.

People with bulimia often have constant stomach pain. In fact, bulimia can actually damage a person's stomach and kidneys as a result of constant vomiting. Bulimia can also cause a person's teeth to decay because of the acids that come up into the mouth while vomiting. The person may also develop "chipmunk cheeks," which occur when the salivary glands permanently expand from throwing up so often. Like girls with anorexia, girls with bulimia may stop getting their periods. And, most dangerous of all, the constant purging can lead to a loss of the mineral potassium, which can contribute to heart problems and even death.

The emotional pain of an eating disorder can take its toll, too. When a person becomes obsessed with weight, it's hard to concentrate on much else. Many times people with eating disorders become withdrawn and less social. Teens with anorexia can't join in on snacks and meals with their friends or families, and they often don't want to break from their intense exercise routine to have fun. Individuals with bulimia often spend a lot of mental energy on planning their next binge, spend a lot of their money on food, and hide in the bathroom for a long time after meals.

Eating disorders are not fun. Both anorexia and bulimia can lead to feelings of guilt and depression. Some individuals with eating disorders begin using drugs or other substances to help mask their feelings, which only makes the situation worse.

Treatment for Eating Disorders

Fortunately, people with eating disorders can get well and gradually learn to eat normally again. Because anorexia and bulimia involve both the mind and body, medical doctors, mental health professionals, and dietitians will often be involved in a person's treatment and recovery.

Therapy or counseling is a critical part of treating eating disorders — in many cases, family therapy is one of the keys to eating healthily again. Parents and other family members are important in helping a person see that his or her normal body shape is perfectly fine and that being thin doesn't make anyone happy.

The most critical thing about treating eating disorders is to recognize and address the problem as soon as possible — like all bad habits, unhealthy eating patterns become harder to break the longer a person takes part in them. If you have an eating disorder, don't wait to get help — anorexia and bulimia can do a lot of damage to the body and mind if left untreated. At worst, eating disorders can kill, and at best, they leave a person feeling and looking terrible.

If you want to talk to someone about eating disorders and you don't feel as though you can approach a parent, try talking to a teacher, a neighbor, your doctor, or another trusted adult. Remember that eating disorders are common among teens, and more importantly, that treatment is out there.

Reviewed by: Barbara P. Homeier, MD
Date reviewed: November 2004
Originally reviewed by: Sandra G. Hassink, MD

Self-Evaluation Quiz
Information Extracted from www.anad.org

• Are you constantly thinking about your weight and food?
• Are you dieting strictly and/or have you lost a lot of weight?
• Are you more than 10% below your healthy weight?
• Are people concerned about your weight?
• Is your energy level down?
• Do you constantly feel cold?
• Are your periods abnormal or have your periods stopped? 
• Are you overeating and feeling out of control?
• Are you vomiting, using laxatives or water pills, herbal agents, or trying to fast as a way to control your weight?
• Are you over exercising or do others consider your exercise excessive ?
• Does your weight drastically fluctuate?
• Do any of the above interfere with your enjoyment of life, relationships, or everyday functioning?

Note: This quiz is not intended to diagnose an eating disorder. It is simply designed to indicate that a person may be thinking too much about food, weight, etc or engaging in potentially eating disordered behaviors.

If you answered yes to more than 5 of these questions, we would encourage you to get a professional evaluation. Please contact ANAD (847-831-3438 or anad20@aol.com ) for a list of professionals and support groups in your area.

Resources - Books

Reviving Ophelia by Mary Pipher, Ph.D. Balantine Books, 1994
The Body Betrayed; Women, Eating Disorders, and Treatment. by Kathryn J.Zerbe M.D. American Psychiatric Association Press, Inc. 1993
Making Weight: Men's Conflicts with Food Weight, Shape & Appearance. by Arnold Andersen, M.D., Leigh Cohn, M.A.T. and Thomas Holbrook, M.D. Gurze Books, 2000
Eating Disorder Program: A Guide to Medical Care and Complications. By Philip S. Mehler M.D. and Arnold E. Andersen M.D.  The John Hopkins University Press. 2000