Images of super-thin models pervade the image of an eating disorder. But eating disorders are complex diseases that put the people who have them at serious risk for long-term problems.
It is estimated that as many as 8 percent of Americans suffer from an eating disorder. However, very few of these people understand that they have a problem. Dr. John Bunnell, expert on eating disorders and director of outpatient clinical services at the Renfrew Center Philadelphia, Pennsylvania, demystifies eating disorders.
What is an eating disorder?
Eating disorders are complex illnesses and not, as I still think many people believe, choices or a form of bad dieting. The two most talked-about types are anorexia nervosa and bulimia nervosa.
What is anorexia?
Anorexia nervosa is a disease in which people restrict or cut back on their food intake. It is usually an intense drive to be thin, a profound fear of fatness or becoming fat. There are two subtypes of anorexia nervosa. The restricting subtype, which is what most people are familiar with, when someone who purely cuts back on food intake. But there's another subtype of people who will self-induce vomiting in order to promote the weight loss.
What is bulimia?
A person with bulimia nervosa will eat an excessive amount of food in a short period of time, usually with a sense of being out of control. Overeating is followed by an attempt to compensate by purging, which may include vomiting, laxatives, diuretics or excessive exercise.
Are there any other types of eating disorders?
There's a third, Not Otherwise Specified (NOS) which broadly covers any other unnatural eating behavior. In fact, that's the biggest category of people with eating disorders. And it encompasses people with anorexic-like behaviors and features but they haven't perhaps lost enough weight to meet the criteria for a full diagnosis. Or for people who have not been purging frequently enough to get the diagnosis of bulimia. But these are still patients who often are in very severe situations; it doesn't mean that they're less ill necessarily.
This also includes binge-eating disorder¾binging without the attempt to compensate. There are actually more people with this eating disorder than with anorexia or bulimia.
U.S. & World
Stories that affect your life across the U.S. and around the world.
Who's at risk for developing an eating disorder?
The most common for anorexia is a young adolescent between the ages of 12 and 14. For bulimia, it's closer to 16 or 17. In both cases, your chance of getting it are much higher if you're female. People with other sorts of psychiatric risks or issues like depression or anxiety are at increased risk for an eating disorder. So, many people with a history of trauma, psychological trauma such as abuse or rape, are at higher risk.
Does peer pressure cause eating disorders?
When we're talking about the tip of the iceberg or the top of the pyramid, meaning people with the fully diagnosed eating disorder, it's increasingly clear that there's a pretty strong genetic or inherited component to it. That vulnerability is something people can then carry into the culture in which they live, and it's the culture that expresses that vulnerability. So, culture plays a role, but the culture in and of itself doesn't cause eating disorders.
What happens to the body when a person has an eating disorder?
A lot of the psychological features we associate with anorexia nervosa are actually secondary to the malnutrition. People tend to get more obsessive, more anxious, their cognitive functioning often gets a little, you know, people don't think abstractly, they get more concrete. Medically, their bodies actually start to shut down: their brain shrinks, their bone stop or their body stops developing bone mass, which is a big risk factor for osteoporosis late in life.
As one gets thinner and thinner, people start to get cold at the extreme, and they'll start to grow body hair.
What are the long-term risks of an eating disorder?
They are significant. So certainly, osteoporosis is an issue, fertility is an issue, the risk of people staying sick and really having this be a big part of their lives for a long time is another risk; that's sort of harder to define or quantify.
But the eating disorder becomes a chronic condition, it really starts to influence all aspects of people's lives: their relationship, their work, obviously their physical health but also their emotional health. So it's a very nasty illness to drag through life.
When should treatment begin?
Certainly, the earlier you can get at it and prevent the person from losing too much weight will helps to insulate the person from some of these medical risks. It makes it easier to engage people in treatment to really avoid some of these longer-term consequences.
But on the other hand, one of the peculiar aspects of this disorder is that people often aren't aware that they are in danger. So, they're not eager to give it up. It's not that they're being difficult or resistant to rebellious. That denial about the risks of the illness is actually part of the illness.
How can you help someone who needs treatment?
People have to be sort of nudged into treatment by the people who love them and care for them because if you wait around and tell the person with anorexia nervosa she's really ready for treatment, she's going to be very, very sick.
What does treatment involve?
The disorders are really complex and treatment ends up being really complex as well. Everyone who has an eating disorder needs to be treated by a treatment team, not just by an individual. That team will often include a therapist or a family therapist or both, a medical physician, often a psychopharmacologist, a psychiatrist, and often a nutritionist.
Recovery for anorexia nervosa always has to entail weight restoration first since it's very hard to do the rest of the work if your brain is starving. Then you need to understand what was going on with them, why it happened at this time, and look at some of the other things that typically go along with it like anxiety and depression to make sure that those are being treated as well.
And now, with bulimia, you don't usually have to promote weight restoration, but you really do help people stop the behavior. That simply binging and purging will make anyone anxious and depressed and sort of chaotic. For bulimia, there's a pretty clear role for the antidepressants.
Is a person ever really cured from these disorders?
I think the majority of patients who receive adequate amounts of quality treatment will fully recover from anorexia and from bulimia.
