Treatment is usually complicated by the fact that most people with the condition deny that they have a problem. They refuse therapy, yet they clearly need help to manage their disorder. Anorexia nervosa rarely goes away on its own.
The goal of therapy for most eating disorders is to restore a normal weight, develop normal eating patterns, overcome unhealthy attitudes about body image and selfworth and provide support to family and friends who may be helping with the recovery process. Because anorexia nervosa has such a widespread influence and affects so many aspects of daily life, effective treatment requires a collaborative effort from a team of health professionals. Often, the team consists of a family physician to manage physical symptoms, a psychiatrist or psychologist to introduce behavioral modification and a nutritionist to establish a healthy diet for recovery.
The sooner anorexia nervosa is identified and treated, the better the eventual outcome. In the early stages, the disorder may be treated without hospitalization. But when weight loss is severe, hospitalization is necessary to restore weight and prevent further physical deterioration. A structured approach that involves careful observation of all eating and elimination—urinating, bowel movements and vomiting—is the first stage of treatment.
When weight is restored and symptoms are stabilized, some type of psychotherapy is required to deal with the underlying emotional issues that trigger the abnormal eating patterns. Family therapy is especially helpful for younger girls, and behavioral or cognitive therapy is also effective in helping replace destructive attitudes with positive ones. A nutritionist will add support by providing advice on proper diet and eating regimens. In some cases, antidepressant medications may be prescribed, but they should not be used as a substitute for appropriate psychological treatment.
Unfortunately, many people with anorexia nervosa have a tendency to relapse and return to dysfunctional eating habits. Long-term therapy and regular health monitoring are essential for a successful result. A strong network of love and support from family and friends is also crucial to the recovery process.
Bulimia nervosa is the most common type of eating disorder. You may also hear it referred to as bingeing and purging. A person with this condition will eat large amounts of high-calorie food in a very short period of time, then use vomiting, diuretics or laxatives to eliminate the food before the body can absorb it. Fasting or excessive exercising are other methods that bulimics may use to counteract the weight gain caused by binge eating.
People suffering from bulimia will binge as often as several times a day, sometimes consuming 10,000 calories or more in a matter of minutes or hours. Comfort foods that are sweet, soft and high in calories, such as ice cream, cake or pastry, are favorite choices for bingeing. Immediately after the binge comes the purge, when
some bulimics will use as many as 20 or more laxatives a day to rid their bodies of these huge quantities of food.
Just like people with anorexia nervosa, bulimics are extremely afraid of becoming fat and are obsessed with body image. They fear food, and yet they consume vast amounts of it. With anorexia nervosa, the extreme weight loss becomes an obvious signal of the disorder. But people with bulimia usually look quite normal and often show few signs of their condition. Their weight may fluctuate wildly, but usually stays within normal ranges. They may even be slightly heavy. Because bulimics are often very secretive about their abnormal behavior, the presence of bulimia can be hard to identify.
As with most eating disorders, bulimia nervosa is a psychological condition. It may be triggered by elevated stress levels and often affects women who are intelligent and high achievers. In many cases, these women are striving to conform to unrealistic ideals of thinness and beauty, and are using food and weight as a means of controlling their underlying emotional problems. People with bulimia nervosa are very aware of their behavior and feel guilty or remorseful. In this way, they are quite unlike anorexics, who deny the existence of their condition. Nearly half of all people with anorexia go on to develop some symptoms of bulimia.
Studies have shown that bulimics are particularly prone to impulsive behavior. They have difficulty dealing with anxiety, have little self-control and often indulge in drug or alcohol abuse or sexual promiscuity. They are also susceptible to depression, anxiety disorders and social phobias. As with anorexia nervosa, people with bulimia have lower levels of brain neurotransmitters, such as serotonin, which may predispose them to developing these psychological disturbances.
In addition to the preoccupation with food and weight that is characteristic of most eating disorders, symptoms of bulimia may include
• evidence of binge eating, large amounts of food going missing, stealing money or food
• food cravings
• frequent weight fluctuations
• evidence of purging, vomiting, abuse of laxatives or diuretics, frequent fasting or excessive exercising
• swelling of glands under the jaw caused by vomiting
• erosion of tooth enamel and other dental problems caused by vomiting
• feelings of shame, self-reproach and guilt
• emotional changes, depression, irritability, social withdrawal
The purging behavior associated with bulimia can also cause physical complications that are very dangerous to long-term health. Vomiting and purging can lead to imbalances in fluids and electrolytes. When potassium levels fall too low, abnormal heart rhythms develop. Some bulimics use a medication called ipecac to induce vomiting; overuse of this substance has been known to cause sudden death.
WHO’S AT RISK?
Like anorexia, bulimia is primarily a women’s disorder. Nearly twice as many women suffer from bulimia as anorexia and, in America, it is estimated that this eating disorder affects up to 2 percent of adolescents and young women. Bulimia tends to develop in later adolescence, often striking young women between the ages of 18 and 20; however, it can appear in earlier adolescence.
As with other eating disorders, bulimia surfaces most often in people who have low self-confidence and are insecure about their appearance. They may be very self-critical and may set unreasonable goals of perfection for themselves. Often, bulimia becomes an issue of control and may be a response to stressful events. Girls reporting sexual or physical abuse are very susceptible to developing an eating disorder such as bulimia. Studies also indicate that the disorder may have a genetic element and may run in families.
Bulimia is usually suspected in people who are obsessed about weight gain and have wide fluctuations in weight, especially if there is evidence of excessive use of laxatives. Swollen salivary glands and tooth decay are also recognizable signs of the disorder. Blood tests may be necessary to identify dehydration, electrolyte imbalances and nutrient deficiencies.
In most cases, people with bulimia are treated without hospitalization. Because it is a psychological condition, cognitive and behavioral therapy are necessary to deal with the emotional issues underlying the symptoms of this disorder. As with anorexia nervosa, a multidisciplinary approach to treatment works best. Physicians, nutritionists and mental health professionals will work together to address the many different facets of this eating disorder. In particular, long-term psychotherapy is needed to help reduce destructive tendencies and develop better coping strategies. Antidepressant medication has proven to be an effective psychological intervention.
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