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Eating Disorders, Anorexia

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Eating Disorders are varied and complex illnesses that span a continuum from self-starvation to compulsive overeating. Falling somewhere in the middle of the continuum is a wide variety of food related disorders such as Bulimia.

There are also lesser know food related problems such as eating only one type of food for a period of time, and emotional eating turning to food for comfort. All of these disorders have related underlying similarities. All of them are problems that need to be recognized and addressed. The following information on both the development of an eating disorder and the termination of one

ANDREA - A Case Study

Andrea was a 23-year-old mother of two. Since high school she had considered herself overweight. She joined a weight loss center to help her loose the extra weight. For weeks she stuck strictly to the new regime and was successful at losing most of the weight she had contracted to loose. Her focus was totally on her diet. Soon, her friends praised her for her new, thinner figure. After loosing the weight, she and her husband moved out of state. She needed to get a job to help support the family, which made it difficult to keep up with her exercise routine. Slowly the weight began to creep back. It wasn't until she went in for an "employee physical" that she panicked. At 5'6", and 152 pounds, her doctor wrote on her form the word obese. Shocked, depressed and humiliated, she decided to take the weight off, once and for all.

At first she ate only what she had to, to get by. Then she began increasing the length of her exercise routine. Before long the illness had her in its grasp, as she began to exhibit symptoms of an eating disorder. Within 3 months she was down to 98 pounds and lying in a hospital room with tubes in her nose, in her arm and down her throat. She was yellow from laxative abuse and the associated liver damage. Her skin was wrinkled and pale, and her eyes sunk into her face as if they were trying to hide from the world. Still, she wasn't convinced that she was thin enough. Her thoughts had left reality and settled on her weight.

Andrea's story is not an uncommon one. Not all anorexics are teenagers who fear growing up, and not all of them start out thin. Research has shown that 45% of all people with either anorexia or bulimia are over age 35. Although Andrea's story is dissimilar to the stereotype in many ways, her underlying problems and feelings were the same. She suffered from a low sense of self-worth, she felt a lack of control over her life and her destiny, and she had a history of family problems that she was not equipped to deal with in a healthy way. Andrea was crying for help. Help with her life - not with her weight.

It is estimated that 5% of the American, female, teenage population suffer from an eating disorder. In the female, college population, that estimate rises to 20-25%. Statistics for males are inconclusive, however in clinical settings, approximately 1% have a diagnosable eating disorder. That means that in an average high school classroom, two girls will have an eating disorder. In a high school with a population of 3,000, at least 15 boys will have an eating disorder. At a University with approximately 30,000 students, as many as 3,750 women and 300 men are suffering. These figures don't include closet bulimia, overeating disorders or eating disorders that aren't clinically diagnosable.

About Anorexia

Anorexia Nervosa is self-starvation. The individual is terrified of gaining weight or maintaining a normal weight. They have a distorted perception of their shape or size, and they may become amenorrheic. An individual with these symptoms can be classified as "clinically anorectic" when they are 15-20% less than normal weight. They are generally in denial about their physical condition, and are often times confused about the realities of their situation. Some (although few) anorexics are "restrictive anorexics," meaning that they loose weight by restricting their intake and doing excessive exercise. Most however, are secretly, binge purgers. They may purge by vomiting and/or by using diuretics or laxatives at least once per week.

Often the individual has a family history of either alcoholism or depression. They may have a tendency towards perfectionism and low self-esteem. At the onset of the disorder they may be suffering intense emotional pain stemming from either family relationships or social pressures. They may feel an inability to deal effectively with their environment and may feel helpless to take charge of their life. The individual who has exhibited symptoms for some time may be in denial about the accurate size of their body, and may compulsively compare themselves to others. The anorexic tends to take pride in their weight loss, gaining a temporary sense of accomplishment and self empowerment by succeeding at losing another pound.

The anorexic may verbally claim to want to gain weight, but secretly, may feel arrogant or proud about their low weight level. Likewise, the anorexic may gain pleasure, or a feeling of being special, by appearing to live without food. It's almost as if they need to show the world how "super human" they are. On the other hand, they inwardly feel "fake." Most secretly crave food. Most binge and purge when their desire for food becomes unbearable. Most anorexics will deny they crave food or binge. To admit this is to admit their failure. They feel ashamed of their behaviors, which increases their stress level - intensifying the symptoms.

In Andrea's case, she began as a restricted anorexic. After initially losing her weight she developed an intense fear of gaining it back. However, because she was human, she began to crave food. Her malnourished body screamed out for anything she saw, smelled or imagined. Before long she began bingeing to satisfy her cravings and purging to keep from gaining weight. Unlike a bulimic, her binge may only have consisted of five cookies or a bowl of plain popcorn. Still she was compelled purge. During the day, she compared herself to others incessantly, feeling superior to those who "had no control over their weight," and feeling inferior to those who appeared thinner. At night she would dream of huge body parts floating in the air around her. Sometimes she would dream of eating huge amounts of food and enjoying it shamelessly. It seemed that there wasn't a moment that her mind wasn't occupied by thoughts of food or body size.

Bulimia

Bulimia Nervosa is characterized by frequent binge eating. Binge eating is consuming an amount of food that is considerably larger than an average meal. The binger generally feels out of control regarding the amount of food eaten. Most frequently, the binger follows the eating-episode with some form of purging such as vomiting and/or the use of laxatives or diuretics. The typical bulimic may exercise in an attempt to counteract the calories consumed but not purged, and/or, may fast for a given period of time afterwards. Although many bulimics are weekend bingers, most binge at least twice per week. As with Anorexia Nervosa, the bulimic's self image is generally distorted and they focus much of their attention on body size and shape. Although some are very thin, many are of normal or even above normal weight.

Bulimic's are usually very ashamed of their strange eating patterns and can become very secretive about it. Some are closet eaters. This is when they arrange their binges in places and at times when they are sure they will not be discovered. This often results in bedroom bingeing, closet bingeing, or bingeing when alone. If left uninterrupted, the bulimic may eat frantically until their body cannot tolerate another bite. The bulimic may then find the will to stop eating, long enough to purge. It is not uncommon for them to resume bingeing once the purge is complete. This may occur throughout the day until the binger is exhausted.

Some may eat more or less fervently depending on the most recent stresses experienced. As bulimics often binge as a way to avoid feelings associated with stress, the binge patterns may ebb and tide accordingly. Specific instances have been documented in which the bulimic binged beyond her stomach's ability to hold the food. Consequently she suffered a ruptured stomach cavity. Some have died from a binge and many have died from serious electrolyte imbalance and/or blood sugar fluctuations. Bulimics may suffer loss of teeth due to continual bath of stomach acids flowing out of their mouth, eroding the enamel. Their intestines can become crippled with holes created by laxative abuse. Liver damage, kidney damage and heart damage is not uncommon. Even if the bulimic is eventually treated and pulls out of the disorder, s/he may be left with serious physical impairments that can result in serious medical problems later in life.

In the case of Andrea, after suffering with anorexia for several years, she developed full bulimia. Her weight fluctuated from month to month, ranging from 80 to 108 pounds. Twice she gained to nearly normal weight levels only to loose it again when her life became hectic. Like most bulimics, she couldn't publicly admit to her binge purge behaviors and binged mostly in the evenings when her children were asleep or when they were out playing. On average she purged 6-10 times per day and although she was in denial (or oblivious) to her dwindling physical health, she was developing serious medical problems.

Over a period of four years, she lost several teeth due to the acid baths from purging. Her remaining front teeth crumbled until they were 20% shorter than normal. Her kidneys failed and she was only hours away from dialyses at one point. Her liver was damaged and her metabolism was seriously impaired, making it nearly impossible for her to readapt to healthy eating patterns and maintain a normal weight. Instead it was likely that when she recovered, her body would overcompensate and gain more than the desired weight. Her bones had lost serious amounts of calcium stores and she began to experience one broken bone after another. She lost all feeling in her limbs from the elbows and knees down, due to vitamin and supplement overdoses. Her heart rhythms were frightfully abnormal and her electrolytes were critically out of balance.

In spite of her failing physical condition, Andrea thought she felt fine. At least that is what she told herself. She was unconcerned for her physical welfare and she was unconvinced that her illness was having an adverse effect on her life. For Andrea, It would be years before she would be able to see clearly what she had done to her body. It would not be until she made a personal commitment to recover that she would begin to free herself from the web of denial she had spun for herself.

Related Disorders

There are many types of food and eating related disorders that have similarities to the better-known anorexia and bulimia. A compulsion to eat only a specific food or food type is less common but can stem from the same types of emotional problems that predispose one to anorexia or bulimia. Chronic or compulsive Overeating is a disorder that is often seen as lack of control or a character flaw because the results are visible, and socially unacceptable.

There are many thousands of people who use food as a barrier or defense against having to experience long repressed feelings. This might manifest in ritualistic or nervous behaviors around eating in public, or eating with family members. It may manifest in extremely picky behavior around what one eats or regarding how food is prepared. Any form of an eating disorder is a red flag that there is something deeper, on a feeling level that needs to be addressed. The disorder itself is not the problem, but merely a symptom.

Compulsive overeaters may not purge what they eat but they are closely related to the bulimic in many ways. Like a bulimic, the overeater may be unconsciously attempting to keep from experiencing painful feelings or memories. They may eat as a diversion to doing so. Emotional eating is when a person has experienced a stressful situation, and instead of dealing with the problem and working through it, they turn to food instead. They may find comfort in eating, like a nurturing friend. They may even realize that they eat more during stressful periods, yet they do not make the effort to deal with their feelings in a healthy way. Most often, compulsive overeaters have several types of eating patterns. Each fills a need for a specific type of emotion or stress.

For instance, having a fight with an ex-husband might be tolerated with an ice cream and cookie binge. A therapy session may be followed by a dinner-food-frenzy. Or, a lonely evening at home may be coupled with hot chocolate, pastries and buttered popcorn. Each type of stress leaves the overeater with a different set of painful feelings. And s/he has learned how to avoid those feelings by compensating with food. No matter how often they attempt to change their eating habits, diet, or stop the compulsion to eat, they will repeatedly fall short of their long range goal until they STOP focusing on the food and start dealing with the pain.

As a child, Andrea loved to eat. Although she spent nearly 17 years as an anorexic and bulimic, it wasn't because she had an aversion to food or because she "didn't like to eat." In fact, one of the common factors binding most people with eating disorders is that they profess to dislike eating, when the truth is that they like eating so much, that they fear that they will not have the ability to control themselves if they give in to it. Anorexics, like bulimics, and compulsive overeater, are obsessed with food.

Andrea recalled that as a child one of her favorite activities was being able to ride her bike to McDonald's every Saturday afternoon. Afterwards she and her friend would go next door to a Speedy Mart and buy candy and comic books until they were broke. In sixth grade she learned how to fake a high temperature, and so began several months of going home early from school where her mother would make her favorite foods to help her feel better. By the time she was in high school, eating was her favorite self-nurturing activity. Her bulimic symptoms began then; bingeing was followed by fasting or exercising. And by the time she was 21 she was 30 pounds overweight. Then began the anorexia.

 



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