Your bright teen-age daughter suddenly steps up her exercise routine and requests low-fat
dinners. Her grades start to drop and she seems withdrawn. A young co-worker seems depressed and
expresses increasing concern about the way she looks. Her weight fluctuates. At lunch you
notice she’s eating as much as usual, maybe even a little more.
The neighbors’ son seems
desperate to stay in his weight class on the wrestling team. At a church dinner you notice
he doesn’t eat any pizza though it’s his favorite food. And, he doesn’t
socialize with his youth group buddies like usual.
On the surface, these behaviors
may seem routine for young adults, but over time, they can signal the onset of an eating
disorder.
Four percent of all females cross
the thin line between healthy and unhealthy concerns about body image. So what pushes
women over the edge while others are able to cope in positive ways? Doctors are still
searching for answers.
“Many women are dissatisfied
with their bodies,” says Dr. Arthur Kelley, chair of the section for child and
adolescent psychiatry at the Wake Forest School of Medicine. “It is endemic in the
United States and other developed countries. But while many women have concerns about body
image, few end up with a disorder. Those who do use food as an attempt to solve other
problems.” Kelley has counseled patients with eating disorders for more than 20
years.
Experts estimate that one percent
of all females are anorexic and three percent are bulimic. (The ratio of males with eating
disorders to women sufferers is 1 to 10.)
Deadly coping strategies
Anorexics starve themselves to
lose weight while bulimics binge and purge.
“Both often start as an
attention to diet,” Kelley says. “The more these women focus on body image,
weight and diet, the more they use it as an attempt to solve other problems.”
A feeling of loss of control is
common among patients with eating disorders, he says. “So they manifest all the
control they can muster on food and the way they look.”
The American Psychiatric
Association reports that the average peak onset of anorexia is age 15 and of bulimia is
the early 20s. Eating disorders are most common among middle- to upper-class females. Most
suffer from low self-esteem and are extremely critical of themselves.
Bulimics tend to be impulsive and
are at higher risk for abuse of drugs and depression. “They are stormy people with a
lot of interpersonal conflicts,” Kelley says. “They have trouble managing their
anger and are extroverted. We’ve found that these patients tend to have heavy family
conflicts.” Bulimics sometimes go through periods of fasting, skipping meals for a
day or two to prepare themselves to overeat later.
Bulimia can be harder to detect
than anorexia because victims purge in private and usually don’t exhibit drastic
weight changes. Bulimics usually lose the enamel from their teeth, have intestinal trouble
and wear their body systems ragged as their hormone and nutrient levels fluctuate.
Anorexics are usually “model
children” who are good students and athletes, and keep their feelings to themselves.
Kelley says they are usually compulsive, perfectionistic people who are overly rigid in
their thinking. “They can’t handle conflict and are total people-pleasers. They
often uncover feelings of a loss of self during therapy.” Anorexics can also
experience periods of purging though this is rare, relegated to the tiny fraction who
start out overweight.
Anorexics almost always suffer
from a semi-starvation syndrome. They grow hair, “lugano,” to keep their bodies
warm as their circulation plummets and struggle to stay mentally clear as they starve
their brains. Their hair gets brittle and their skin dries and yellows. Joint pain,
constipation, anemia and wasting away of muscles are other common symptoms.
Crossing the line
Meredith Julian, 15, says she
doesn’t remember what caused her to become anorexic last fall. “I wasn’t
understanding why, but I was just upset all the time,” she remembers. “I
didn’t feel like being around people and I was so unhappy with myself. And
that’s when I started controlling my food because it made me feel better.”
Today, almost a year later, Julian
is in the early stages of recovery. She has been hospitalized three times, underwent daily
outpatient treatment for four months and continues to meet with Kelley and a nutritionist
on a weekly basis.
At 5-foot-three-inches,
Julian’s lowest weight was a skeletal 62 pounds. “And even then I felt like I
was fat,” she remembers.
Julian says the most difficult
part of being anorexic has been admitting that the disorder is not just about food and
body image. “Because once I realized that, I knew I had to deal with what was really
wrong with me — the way I handle my problems is unhealthy. I wanted something to
control because I was mad at my parents and I chose my weight.”
Kelley says women who develop
eating disorders share common fears and problems, namely about adult sexuality and
relationships with parents, peers and the opposite sex. Younger girls often have maturity
fears. “Some are scared to develop a woman’s body so they try to prevent it with
food,” Kelley says.
Two-pronged treatment
Treatment for eating disorders
must be two-pronged to be effective, Kelley says. “You have to deal with the eating
issues and the underlying, psychological issues.”
Eating disorders have built-in
reinforcers that trap young women into repeating behaviors they know can be fatal.
“As women lose weight,people take notice and usually give them positive feedback.
This sends the message that while these women can’t deal with their parents or
whatever their core issue really is, they can be good at losing weight.”
Kelley says the more educated the
public becomes about eating disorders, the more likely it is that early detection will
occur. Quick exposure of an eating disorder increases the victim’s chance for
survival.
Warning signs for both eating
disorders include unexplained loss of menstrual periods, abnormal dental problems,
unexplained fainting, leaving the table after meals and the disappearance of large
quantities of food. “I had one patient who was found out when she ate a box of dry
cake mix,” Kelley says.
It is possible to help prevent
your child from developing an eating disorder, Kelley says.
Kelley says parents can help boost
their children’s self-esteem, which can help prevent the development of an eating
disorder.
“It sounds cliche, but we
need to be less focused on what we look like and more on who we are,” he says.
“Parents need to help
identify their children’s personality strengths early on and not be so
performance-oriented. Say you’re proud of your son because he’s honest —
Watch for these
warning signs
Nutritionist Carol Beck is the
co-author of “Full and Fulfilled: The Science of Eating to Your Soul’s
Satisfaction.” The book is available through special orders at local bookstores.
Below, she offers a list of questions that could help you detect an eating disorder in
your child or someone you love.
1. Does she spend a great deal of
time each day thinking about what she has eaten or will eat, or about the clothes she will
be able to fit in?
2. Is her schedule affected by
concern about food and weight?
3. How much of her conversation is
about food, her weight or her looks?
4. Is she refusing to talk about
food or weight, even though you have noticed a distinct change?
5. Is she using the scale to
determine what and how much she eats, what she wears or where she will (or will not) go
each day? 6. Does she go to the bathroom each time after she eats?
7. Is she spending more and more
time exercising?
8. Is she developing specific food
rituals she believes she must follow — what she eats, the order she eats food within
a meal, the plate she uses, etc? |
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