Eating Disorders
By Jaclyn Kong (5sc3)
Eaing Disorders Are So Common In America That 1 Or 2 Out Of Every 100 Students Will Struggle With One.
Eating Disorders Are More Than Just Going On A Diet To Lose Weight Or Trying To Make Sure You Exercise Every Day. They're Extremes In Eating Behavior — The Diet That Never Ends And Gradually Gets More Restrictive, For Example. Or The Person Who Can't Go Out With Friends Because He Or She Thinks It's More Important To Go Running To Work Off A Piece Of Candy.
The Most Common Types Of Eating Disorder Are Anorexia Nervosa And Bulimia Nervosa (Usually Called Simply "Anorexia" And "Bulimia"). But Other Food-Related Disorders, Like Binge Eating Disorders, Body Image Disorders, And Food Phobias, Are Showing Up More Frequently Than They Used To.
Anorexia
People With Anorexia Have An Extreme Fear Of Weight Gain And A Distorted View Of Their Body Size And Shape. As A Result, They Can't Maintain A Normal Body Weight. Some People With Anorexia Restrict Their Food Intake By Dieting, Fasting, Or Excessive Exercise. They Hardly Eat At All — And The Small Amount Of Food They Do Eat Becomes An Obsession.
Other People With Anorexia Do Something Called Binge Eating And Purging, Where They Eat A Lot Of Food And Then Try To Get Rid Of The Calories By Forcing Themselves To Vomit, Using Laxatives, Or Exercising Excessively.
Bulimia
Bulimia Is Similar To Anorexia. With Bulimia, A Person Binge Eats (Eats A Lot Of Food) And Then Tries To Compensate In Extreme Ways, Such As Forced Vomiting Or Excessive Exercise, To Prevent Weight Gain. Over Time, These Steps Can Be Dangerous.
To Be Diagnosed With Bulimia, A Person Must Be Binging And Purging Regularly, At Least Twice A Week For A Couple Of Months. Binge Eating Is Different From Going To A Party And "Pigging Out" On Pizza, Then Deciding To Go To The Gym The Next Day And Eat More Healthfully. People With Bulimia Eat A Large Amount Of Food (Often Junk Food) At Once, Usually In Secret. The Person Typically Feels Powerless To Stop The Eating And Can Only Stop Once He Or She Is Too Full To Eat Any More. Most People With Bulimia Then Purge By Vomiting, But May Also Use Laxatives Or Excessive Exercise.
Although Anorexia And Bulimia Are Very Similar, People With Anorexia Are Usually Very Thin And Underweight But Those With Bulimia May Be A Normal Weight Or Even Overweight.
Binge Eating Disorder
This eating disorder Is Similar To Anorexia And Bulimia Because A Person Binges Regularly On Food (More Than Three Times A Week). But, Unlike The Other Eating Disorders, A Person With Binge Eating Disorder Does Not Try To "Compensate" By Purging The Food.
Anorexia, Bulimia, And Binge Eating Disorder All Involve Unhealthy Eating Patterns That Begin Gradually And Build To The Point Where A Person Feels Unable To Control Them.
Anorexia And Bulimia: What To Look For
Sometimes A Person With Anorexia Or Bulimia Starts Out Just Trying To Lose Some Weight Or Hoping To Get In Shape. But The Urge To Eat Less Or To Purge Spirals Out Of Control.
People With Anorexia Or Bulimia Frequently Have An Intense Fear Of Being Fat Or Think That They Are Fat When They Are Not. A Person With Anorexia May Weigh Food Before Eating It Or Compulsively Count The Calories Of Everything. When It Seems "Normal" Or "Cool" To Do Things Like Restrict Food Intake To An Unhealthy Level, It's A Sign That A Person Has A Problem.
So How Do You Know If A Person Is Struggling With Anorexia Or Bulimia? You Can't Tell Just By Looking At Someone. A Person Who Loses A Lot Of Weight May Have Another Health Condition Or May Be Losing Weight Through Healthy Eating And Exercise.
Here Are Some Signs That A Person May Have Anorexia Or Bulimia:
Anorexia
1. Becomes Very Thin, Frail, Or Emaciated
2. Obsessed With Eating, Food, And Weight Control
3. Weighs Herself Or Himself Repeatedly
4. Counts Or Portions Food Carefully
5. Only Eats Certain Foods, Avoiding Foods Like Dairy, Meat, Wheat, Etc. (Of Course
6. Lots Of People Who Are Allergic To A Particular Food Or Are Vegetarians Avoid Certain Foods)
7. Exercises Excessively
8. Feels Fat
9. Withdraws From Social Activities, Especially Meals And Celebrations Involving Food
10. May Be Depressed, Lethargic (Lacking In Energy), And Feel Cold A Lot
Bulimia
1. Fears Weight Gain
2. Intensely Unhappy With Body Size, Shape, And Weight
3. Makes Excuses To Go To The Bathroom Immediately After Meals
4. May Only Eat Diet Or Low-Fat Foods (Except During Binges)
5. Regularly Buys Laxatives, Diuretics, Or Enemas
6. Spends Most Of His Or Her Time Working Out Or Trying To Work Off Calories
7. Withdraws From Social Activities, Especially Meals And Celebrations Involving Food
What Causes Eating Disorders?
No One Is Really Sure What Causes Eating Disorders, Although There Are Many Theories About Why People Develop Them. Many People Who Develop An Eating Disorder Are Between 13 And 17 Years Old. This Is A Time Of Emotional And Physical Changes, Academic Pressures, And A Greater Degree Of Peer Pressure. Although There Is A Sense Of Greater Independence During The Teen Years, Teens Might Feel That They Are Not In Control Of Their Personal Freedom And, Sometimes, Of Their Bodies. This Can Be Especially True During Puberty.
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. They Might Mistakenly Feel Compelled To Get Rid Of It Any Way They Can.
When You Combine The Pressure To Be Like Celeb Role Models With The Fact That During Puberty Our Bodies Change, It's Not Hard To See Why Some Teens Develop A Negative View Of Themselves.
Many People With Eating Disorders Also Can Be Depressed Or Anxious, Or Have Other Mental Health Problems Such As Obsessive-Compulsive Disorder (OCD). There Is Also Evidence That Eating Disorders May Run In Families. Although Part Of This May Be Our In Genes, It's Also Because We Learn Our Values And Behaviors From Our Families.
Sports And Eating Disorders
Athletes And Dancers Are Particularly Vulnerable To Developing Eating Disorders Around The Time Of Puberty, As They May Want To Stop Or Suppress Growth (Both Height And Weight).Coaches, Family Members, And Others May Encourage Teens In Certain Sports — Such As Gymnastics, Ice-Skating, And Ballet — To Be As Thin As Possible. Some Athletes And Runners Are Also Encouraged To Weigh Less Or Shed Body Fat At A Time When They Are Biologically Destined To Gain It.
Effects Of Eating Disorders
Eating Disorders Are Serious Medical Illnesses. They Often Go Along With Other Problems Such As Stress, Anxiety, Depression, And Substance Use. People With Eating Disorders Also Can Have Serious Physical Health Problems, Such As Heart Conditions Or Kidney Failure. 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. In Severe Cases, Eating Disorders Can Lead To Severe Malnutrition And Even Death.
With Anorexia, The Body Goes Into Starvation Mode, And The Lack Of Nutrition Can Affect The Body In Many Ways:
1. A Drop In Blood Pressure, Pulse, And Breathing Rate
2. Hair Loss And Fingernail Breakage
3. Loss Of Periods
4. Lanugo Hair — A Soft Hair That Can Grow All Over The Skin
5. Lightheadedness And Inability To Concentrate
6. Anemia
7. Swollen Joints
8. Brittle Bones
8. Brittle Bones
With Bulimia, Constant Vomiting And Lack Of Nutrients Can Cause These Problems:
1. Constant Stomach Pain
2. Damage To A Person's Stomach And Kidneys
3. Tooth Decay (From Exposure To Stomach Acids)
4. "Chipmunk Cheeks," When The Salivary Glands Permanently Expand From Throwing Up So Often
5. Loss Of Periods
6. Loss Of The Mineral Potassium (This Can Contribute To Heart Problems And Even Death)
7.A Person With Binge Eating Disorder Who Gains A Lot Of Weight Is At Risk Of 8.Developing Diabetes, Heart Disease, And Some Of The Other Diseases Associated With Being overweight.
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 People With Eating Disorders Become Withdrawn And Less Social. People With Eating Disorders Might Not 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.
People With Eating Disorders Often Spend A Lot Of Mental Energy On Planning What They Eat, How To Avoid Food, Or Their Next Binge, Spend A Lot Of Their Money On Food, Hide In The Bathroom For A Long Time After Meals, Or Make Excuses For Going On Long Walks (Alone) After A Meal.
Treatment For Eating Disorders
Fortunately, People With Eating Disorders Can Get Well And Gradually Learn To Eat Normally Again. Eating Disorders Involve Both The Mind And Body. So 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 Excessively Thin Can Be Dangerous.
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 Very Common Among Teens. Treatment Options Depend On Each Person And Their Families, But Many Options Are Available To Help You Overcome An Eating Disorder. Therapy Can Help You Feel In Charge Again And Learn To Like Your Body, Just As It Is.
Source:http://sginteract.co.nr
Source:http://sginteract.co.nr
Defining Characteristics Of Binge Eating Disorder:
Binge Eating Disorder Is A Relatively Recently Recognized Disorder (It Is Sometimes Referred To As Compulsive Overeating). Some Researchers Believe It Is The Most Common Of The Eating Disorders Affecting Millions Of Americans. Similar To Bulimia Nervosa, Those With Binge Eating Disorder Frequently Consume Large Amounts Of Food While Feeling A Lack Of Control Over Their Eating. However, This Disorder Is Different From Bulimia Nervosa Because People With Binge Eating Disorder Usually Do Not Purge (I.E. Vomiting, Laxatives, Excessive Exercise, Etc) Their Bodies Of The Excess Food They Consume During A Binge Episode.
Diagnostic Criteria: DSM-IV
A. Recurrent Episodes Of Binge Eating. An Episode Is Characterized By:
1. Eating A Larger Amount Of Food Than Normal During A Short Period Of Time (Within Any Two Hour Period)
2. Lack Of Control Over Eating During The Binge Episode (I.E. The Feeling That One Cannot Stop Eating).
B. Binge Eating Episodes Are Associated With Three Or More Of The Following:
1. Eating Until Feeling Uncomfortably Full
2. Eating Large Amounts Of Food When Not Physically Hungry
3. Eating Much More Rapidly Than Normal
4. Eating Alone Because You Are Embarrassed By How Much You're Eating
5. Feeling Disgusted, Depressed, Or Guilty After Overeating
C. Marked Distress Regarding Binge Eating Is Present
D. Binge Eating Occurs, On Average, At Least 2 Days A Week For Six Months
E. The Binge Eating Is Not Associated With The Regular Use Of Inappropriate Compensatory Behavior (I.E. Purging, Excessive Exercise, Etc.) And Does Not Occur Exclusively During The Course Of Bulimia Nervosa Or Anorexia Nervosa.
*From The DSM-IV, Diagnostic And Statistical Manual Of Mental Disorders, Fourth Edition, Washington D.C.: American Psychiatric Association, 1994.
Some Warning Signs:
5. Feeling Disgusted, Depressed, Or Guilty After Overeating
C. Marked Distress Regarding Binge Eating Is Present
D. Binge Eating Occurs, On Average, At Least 2 Days A Week For Six Months
E. The Binge Eating Is Not Associated With The Regular Use Of Inappropriate Compensatory Behavior (I.E. Purging, Excessive Exercise, Etc.) And Does Not Occur Exclusively During The Course Of Bulimia Nervosa Or Anorexia Nervosa.
*From The DSM-IV, Diagnostic And Statistical Manual Of Mental Disorders, Fourth Edition, Washington D.C.: American Psychiatric Association, 1994.
Some Warning Signs:
| Rapid Weight Gain Or Obesity | |
| - Constant Weight Fluctuations | |
| - Frequently Eats An Abnormal Amount Of Food In A Short Period Of Time (Usually Less Than Two Hours) | |
| - Does Not Use Methods To Purge Food | |
| - Eats Rapidly (I.E. Frequently Chewing Without Swallowing) | |
| - Feeling A Lack Of Control Over One's Eating (I.E. Unable To Stop) | |
| - Eating Alone, "Secretive Eating Habits", Hiding Food, Etc. | |
| - Eating Late At Night | |
| - Eating When Not Hungry | |
| - Disgust And Shame With Self After Overeating. | |
| - Hoarding Food (Especially High Calorie/Junk Food) | |
| - Coping With Emotional And Psychological States Such As Stress, Unhappiness Or Disappointment By Eating. | |
| - Eating Large Amounts Of Food Without Being Hungry | |
| - Consuming Food To The Point Of Being Uncomfortable Or Even In Pain | |
| - Attribute Ones Successes And Failures To Weight | |
| - Avoiding Social Situations Especially Those Involving Food. | |
| - Depressed Mood | |
| - Anxious Mood |
Some Medical Consequences:
 | Obesity |
| | Diabetes |
| | High Blood Pressure |
| | High Cholesterol |
| | Kidney Disease And/Or Failure |
| | Gallbladder Disease |
| | Arthritis |
| | Bone Deterioration |
| | Stroke |
| | Upper Respiratory Problems |
| | Skin Disorders |
| | Menstrual Irregularities |
| | Ovarian Abnormalities |
| | Complications Of Pregnancy |
| | Depression, Anxiety And Other Mood Disorders |
| | Suicidal Thoughts |
| | Substance Abuse |
Treatment Options:
Studies Have Found That People With Binge Eating Disorder May Find It Harder Than Other People To Continue In Weight Loss Treatment. In Addition, They May Be More Likely To Regain Weight Quickly. These Are Some Of The Reasons That People With Binge Eating Disorder May Require Treatment That Focuses On Their Binge Eating Before They Try To Lose Weight. Further, Even Those Who Are Not Overweight Are Frequently Distressed By Their Binge Eating And May Benefit From Treatment.
There Are Several Methods Currently Used To Treat Binge Eating Disorder.
A. Cognitive-Behavioral Therapy: Method In Which The Client Is Taught Techniques To Monitor And Change Their Eating Habits, As Well As To Change The Way They Respond To Difficult And Stressful Situations.
B. Interpersonal Psychotherapy: Method In Which The Client Is Taught To Examine Their Relationships With Friends And Family And To Make Changes In Problem Areas.
C. Medications: Antidepressants May Be Helpful For Some Individuals.
D. Self-Help Groups: These Groups May Be A Good Additional Source Of Support For Many.
Research Is Still Trying To Attempting To Determine Which Method Or Combination Of Methods Is The Most Effective In Controlling Binge Eating Disorder.
Often Those Who Have Binge Eating Disorder Suffer With The Disorder For Years, Feel Ashamed, Depressed May Feel Very Alone. It Is Important To Recognize That You Are Not Alone, There Are Millions Like You And There Are Successful Treatment Options Available For You.
To Determine The Type Of Treatment That Is Best Suited For Your Situation Treatment Options Should Be Discussed With A Licensed Mental Health Practitioner Who Can Assess Your Needs.
Diabulimia - What Is It?
Diabulimia Is An Eating Disorder In Which People With Type 1 Diabetes Deliberately Give Themselves Less Insulin Than They Need For The Purpose Of Weight Loss. When Insulin Is Omitted, Calories Are Purged Through The Loss Of Glucose In The Urine. Individuals With Diabulimia Manipulate Insulin As An Inappropriate Behavior To Prevent Weight Gain. This Is One Of The Criteria Of Bulimia Nervosa.1 Clinicians Have Not Defined The Frequency And Duration Of Insulin Omission And Many Do Not Recognize This Dual Condition As A Disorder. Some Propose The Following Definition: An Insulin Reduction At Least Twice A Week Or Of Over One Quarter Of The Prescribed Insulin For The Purpose Of Weight Loss For More Than Three Months.2,3
The Term "Diabulimia" Started To Surface Among Public And Health Communities Through News, Magazines, And Health Journals In The Summer Of 2007. 4,5
Although Diabulimia Is Not Yet A Recognized Medical Term, Cases Of Type 1 Diabetes Combined With Eating Disorders Have Been Published Since The 1970s And Early 1980s. 6,7,8,9 In The Past Few Years, The Prevalence Has Ranged From 11 Percent To 39 Percent 10,11,12 Among Type 1 Diabetes, Depending On The Sample Size, The Age Group, And The Geographic Area. 13,14 Studies Were Conducted Through Self-Report Questionnaires. Because Some People Do Not Return Surveys And Some People Don't Tell The Full Stories During Their Interviews, Researchers Believe That The Actual Prevalence Of Type 1 Combined With An Eating Disorder Could Be Much Higher. 15
Who Has Diabulimia And What Are The Complications?
Inadequate Blood Glucose Control Might Result In Slow Growth And Development In Some Teenagers. 16 In One Long-Term Study, Teenagers With Type 1 Diabetes Who Misused Insulin To Prevent Weight Gain Had Serious Medical Consequences In Adulthood. Some Suffered From Eye Problems Ranging From Blurred Version To Requiring Laser Surgery To Blindness; Kidney Failure Which For Some Required Dialysis; Or Foot Ulcers Necessitating Amputation.17,18,19 According To One Study, The Painful Sensation From Nerve Damage Caused By Uncontrolled Blood Glucose Coincided With The Peak Of Weight Loss. Remission Of Pain Occurred As Weight Was Regained. 20 The Published Evidence Of Complications From Type 1 Diabetes With Disordered Eating Behavior Is Staggering. The Death Rate Of Type 1 Diabetes Was Three Times Those Who Had Eating Disorders Compared To Those Who Did Not. 21
Recently I Received A Phone Call From A Woman, Lucy, Who Was In Tears. "I Am Forty And Have Been Battling An Eating Disorder And Diabetes For Twenty-Five Years. I Skip Shots And Have Numerous Diabetes Complications. I Now Use A Wheelchair Because Of A Foot Ulcer And Neuropathy. Please Help Some Younger People Who Have Not Yet Destroyed Their Bodies Like Me. I Have No Hope Now." Another Woman Wrote, "I Have Done So Much Damage To My Body That I Feel More Like 75 Years Old Instead Of 35 Years Old. And I Have Completely Ruined My Chance Of Having Children."
Unfortunately, Few Teenagers Are Willing To Face The Long-Term Consequences Of Their Actions. Patricia, A Sixteen-Year-Old, Said To Me "Many People Tried To Scare Me With Talk Of Kidney Dialysis. Don't Worry," She Said, "I Would Have Killed Myself By The Time I Needed Dialysis."
One Out Of Five Adolescents With Type 1 Diabetes Suffers From Depression, According To Studies. 14 This Further Worsens The Prognosis And Outcome Of This Serious And Deadly Condition.
Diabulimia Can Affect Anyone Who Wants To Lose Weight. Joyce Was 13 When She Was Diagnosed With Type 1. According To Her, She Was Obese Through Her Life Until She Lost Forty Pounds For A Couple Months Prior To Diagnosis Of Diabetes. Within Few Weeks Of Insulin Management, She Regained The Water She Was Missing And Recovered Some Of The Lost Tissue Mass. She Gained 25 Pounds. It Didn't Take Long For Her To Figure Out That She Could Refuse Insulin When She Wished To Feel Good About Being Slim.
What To Watch For
Some Of The Common Warning Signs For Families And Friends To Watch For:
Consistent High Hemoglobin A1c (Glycosylated Hemoglobin) Or EAG (Estimated Average Glucose).
Glycosylated Hemoglobin, Or A1c, Tests Provide An Index To The Average Blood Glucose Level Over A Period Of Approximately Three Months.2 Estimated Average Glucose Uses The Same Units (Mg/Dl) That Patients See Routinely.22
Frequent Emergency Room Visits For Diabetic Ketoacidosis (DKA) May Be An Indicator Of The Presence Of An Eating Disturbance.17 That Said, Some Patients With Diabulimia Skip Rapid-Acting Insulin And Continue To Take Basal Insulin, And They May Not Experience DKA. Average Glucose Of 250 To 400 Mg/Dl Is Common. Patricia, The Teenager Who Couldn't Face Long Term-Consequences, Had An A1c Of Around 14. Joyce, The Teen Who Disliked Gaining Back All The Weight She Lost Pre-Diagnosis, Had An A1c That Never Fell Below 11.
Body Image Concerns
Individuals Who Suffer From Diabulimia May Be Underweight, Overweight, Or Within A Good Weight Range. They Show A Significant Increase In Drive For Thinness And Body Dissatisfaction 23. Joyce Continued To Struggle With Being 25 Pounds Overweight. She Weighed Herself Twice A Day; If There Was Any Ounce Of Weight Gain On The Scale, She Skipped Insulin And Meals. Patricia Was In A Good Weight Range, Yet Regarded Herself As Fat. She Wished To Lose At Least 15 Pounds.
Irregular Eating Patterns
The Eating Behavior Of Diabulimia Is Very Similar To The Eating Pattern Of Bulimia Nervosa.
Individuals May Restrict Intake, Skip Meals, And Eliminate Sweets And Fats With The Intention Of Losing Weight. This Behavior Is Followed By An Intense Over-Eating And Sense Of Guilt. The Individuals Then Proceed To Limit Their Eating Or Avoid Taking Insulin. The Vicious Cycle Repeats. The Intention For People With Diabulimia Is To Lose Weight, And Some May Demonstrate Weight Loss In A Period Of Time. However, The Erratic Eating Behavior Slows The Metabolism, And Lasting Weight Loss Seldom Occurs.
Discomfort Eating Around Other People
Because Of Their Irregular Eating Behavior, Individuals With Diabulimia Prefer Not To Eat Around Other People, Especially When They Have The Urge To Overeat. Even If They Sit With Their Family At The Dining Table, They Will Choose Foods With Fewer Calories And Eat Small Portions. Patricia Refused To Eat Breakfast With Her Family Or Lunch With Classmates, Yet As Soon As She Came Home From School She Ate A Big Bag Of Chips And A Half Dozen Cookies In Private.
Hoarding Food Without Insulin, Nutrients Cannot Get To The Cells. When The Cells Need Nutrients, The Individual Feels Hungry. To Satisfy Hunger, They Crave Food. But Patients With Diabulimia May Feel Guilty, Defeated, Or Ashamed When They Lose Control Over Their Hunger. Therefore, They May Hoard Foods And Eat Alone During Weak Moments.
Joyce's Parents Could Not Understand Why They Kept Finding Candy Bar Wrappers In Her Room When She Claimed That She Was On A Diet To Lose Weight.
Irregular Or Nonexistent Menses
High A1c Levels Have Been Reported To Cause Irregular Menses, Cessation Of Periods, And Delayed Puberty Due To Interference With The Function Of The Brain.16 Joyce Had Not Yet Started Her Menstruation Cycles At The Age Of 15, And Patricia Had Irregular Menses.
Unwillingness To Follow Through With Appointments
Fourteen-Year-Old Mary Cried Out For Help With Three DKA Episodes. On Her Third Visit To The Emergency Room, She Told The Doctors That She Had Not Been Taking Insulin At Home; She Needed Help And Wished To Be Admitted To The Hospital. She Was, And After Discharge, She Was Referred To An Endocrinologist And A Psychotherapist For Follow-Up Treatment. Her Pediatrician Also Referred Her To Me For Nutritional Counseling.
Her Parents Could Not Accept That Eating Disorders Might Have Played A Role In Mary's Diabetes. They Requested That The Endocrinologist Prescribe The "Right Dose" Of Insulin And Teach Her The "Correct Information." After The Initial Nutritional Evaluation, Her Parents Cancelled The Appointment With Me. "The Dietitian Didn't Really Fix Her Eating," Her Parents Said To Her Pediatrician. Mary's Parents Didn't Follow Through With Her Therapist Either. They Believed Mary's Problem Was Strictly Medical And Not Psychological.
I Can Only Imagine How Helpless And Hopeless Mary Must Have Felt. She Finally Got A Health Team's Attention, But Then Her Parents Could Not Support Her Treatment.
In Another Case, A Mother Recognized How Much Her 22-Year-Old Daughter, Susan, Was Struggling. She Saw Susan Curl Like A Ball In The Corner Of Her College Dorm Room When She Visited Her. Susan Was Tired And Nauseous Most Of The Time From Hyperglycemia. When Her Mother Checked, There Seemed To Be The Same Amount Of Insulin In The Fridge As There Was A Week Ago.
Susan's Mom Arranged Multiple Appointments For Her Daughter's Diabetes Care, But Susan Managed To Make One Excuse After Another And Cancelled The Appointments.
Due To The Unwillingness Of The Individuals To Get Well And The Lack Of Awareness And Information For The Families, Follow-Up Treatment For Diabulimia Is A Great Challenge.
Doubtful Blood Glucose Monitoring
If The Numbers Shown In Blood Glucose Meters Seem Too Good To Be True, They Are.
Patricia Informed Me That A Specific Proportion Of Water And Milk Substituted For Blood On The Test Strip Produced An Ideal Reading Of Blood Glucose Below 200mg/DL. That Was How She Convinced The Health Providers And Her Mother That She Checked Her Blood Glucose And That The Readings Were Fine. If Her Mother's Suspicions Were Raised By Those Almost Perfect Numbers, Patricia Then Mixed Juice With Water To Increase The Number Of The Reading.
In Both The Diabetes Clinic At Children's Hospital At Stanford And My Nutrition Counseling Private Practice Offices, I Observed The Feigned Forgetfulness Of Those Who Practiced Diabulimia. They Claimed They Forgot To Bring Their Meters; They Forgot To Enter Carbohydrates Consumed Onto Their Insulin Pump; Or They Forgot The Trend Of Their Blood Glucose. Either They Didn't Want Me To Know The Truth, Or They Didn't Think I Could Handle The Truth. Yet The Truth Was That They Were Taking Less Than Their Prescribed Insulin And Managing Their Diabetes Poorly.
There Have Been Few Studies Conducted To Determine Treatments For Diabulimia.
The Following Are What I Have Compiled From A Few Articles, From Talking To Health Professionals, And (Chiefly) Through My Own Experiences.
Proposed Treatment Plans For Diabulimia
Inpatient Treatment
Some Individuals Require Hospitalization To Achieve Metabolic Control. Those With Symptoms Of Complications May Also Need Inpatient Treatment.
Multi-Disciplinary Team Approach
If Hospitalization Is Not Yet Necessary, Individuals With Diabulimia Should Be Followed By A Team Of Experts. For Successful Treatment Of The Multi-Faceted Symptoms And Behavior Of Diabulimia, A Multi-Disciplinary Team Approach Is Crucial. This Team Should Include:
The Term "Diabulimia" Started To Surface Among Public And Health Communities Through News, Magazines, And Health Journals In The Summer Of 2007. 4,5
Although Diabulimia Is Not Yet A Recognized Medical Term, Cases Of Type 1 Diabetes Combined With Eating Disorders Have Been Published Since The 1970s And Early 1980s. 6,7,8,9 In The Past Few Years, The Prevalence Has Ranged From 11 Percent To 39 Percent 10,11,12 Among Type 1 Diabetes, Depending On The Sample Size, The Age Group, And The Geographic Area. 13,14 Studies Were Conducted Through Self-Report Questionnaires. Because Some People Do Not Return Surveys And Some People Don't Tell The Full Stories During Their Interviews, Researchers Believe That The Actual Prevalence Of Type 1 Combined With An Eating Disorder Could Be Much Higher. 15
Who Has Diabulimia And What Are The Complications?
Inadequate Blood Glucose Control Might Result In Slow Growth And Development In Some Teenagers. 16 In One Long-Term Study, Teenagers With Type 1 Diabetes Who Misused Insulin To Prevent Weight Gain Had Serious Medical Consequences In Adulthood. Some Suffered From Eye Problems Ranging From Blurred Version To Requiring Laser Surgery To Blindness; Kidney Failure Which For Some Required Dialysis; Or Foot Ulcers Necessitating Amputation.17,18,19 According To One Study, The Painful Sensation From Nerve Damage Caused By Uncontrolled Blood Glucose Coincided With The Peak Of Weight Loss. Remission Of Pain Occurred As Weight Was Regained. 20 The Published Evidence Of Complications From Type 1 Diabetes With Disordered Eating Behavior Is Staggering. The Death Rate Of Type 1 Diabetes Was Three Times Those Who Had Eating Disorders Compared To Those Who Did Not. 21
Recently I Received A Phone Call From A Woman, Lucy, Who Was In Tears. "I Am Forty And Have Been Battling An Eating Disorder And Diabetes For Twenty-Five Years. I Skip Shots And Have Numerous Diabetes Complications. I Now Use A Wheelchair Because Of A Foot Ulcer And Neuropathy. Please Help Some Younger People Who Have Not Yet Destroyed Their Bodies Like Me. I Have No Hope Now." Another Woman Wrote, "I Have Done So Much Damage To My Body That I Feel More Like 75 Years Old Instead Of 35 Years Old. And I Have Completely Ruined My Chance Of Having Children."
Unfortunately, Few Teenagers Are Willing To Face The Long-Term Consequences Of Their Actions. Patricia, A Sixteen-Year-Old, Said To Me "Many People Tried To Scare Me With Talk Of Kidney Dialysis. Don't Worry," She Said, "I Would Have Killed Myself By The Time I Needed Dialysis."
One Out Of Five Adolescents With Type 1 Diabetes Suffers From Depression, According To Studies. 14 This Further Worsens The Prognosis And Outcome Of This Serious And Deadly Condition.
Diabulimia Can Affect Anyone Who Wants To Lose Weight. Joyce Was 13 When She Was Diagnosed With Type 1. According To Her, She Was Obese Through Her Life Until She Lost Forty Pounds For A Couple Months Prior To Diagnosis Of Diabetes. Within Few Weeks Of Insulin Management, She Regained The Water She Was Missing And Recovered Some Of The Lost Tissue Mass. She Gained 25 Pounds. It Didn't Take Long For Her To Figure Out That She Could Refuse Insulin When She Wished To Feel Good About Being Slim.
What To Watch For
Some Of The Common Warning Signs For Families And Friends To Watch For:
Consistent High Hemoglobin A1c (Glycosylated Hemoglobin) Or EAG (Estimated Average Glucose).
Glycosylated Hemoglobin, Or A1c, Tests Provide An Index To The Average Blood Glucose Level Over A Period Of Approximately Three Months.2 Estimated Average Glucose Uses The Same Units (Mg/Dl) That Patients See Routinely.22
Frequent Emergency Room Visits For Diabetic Ketoacidosis (DKA) May Be An Indicator Of The Presence Of An Eating Disturbance.17 That Said, Some Patients With Diabulimia Skip Rapid-Acting Insulin And Continue To Take Basal Insulin, And They May Not Experience DKA. Average Glucose Of 250 To 400 Mg/Dl Is Common. Patricia, The Teenager Who Couldn't Face Long Term-Consequences, Had An A1c Of Around 14. Joyce, The Teen Who Disliked Gaining Back All The Weight She Lost Pre-Diagnosis, Had An A1c That Never Fell Below 11.
Body Image Concerns
Individuals Who Suffer From Diabulimia May Be Underweight, Overweight, Or Within A Good Weight Range. They Show A Significant Increase In Drive For Thinness And Body Dissatisfaction 23. Joyce Continued To Struggle With Being 25 Pounds Overweight. She Weighed Herself Twice A Day; If There Was Any Ounce Of Weight Gain On The Scale, She Skipped Insulin And Meals. Patricia Was In A Good Weight Range, Yet Regarded Herself As Fat. She Wished To Lose At Least 15 Pounds.
Irregular Eating Patterns
The Eating Behavior Of Diabulimia Is Very Similar To The Eating Pattern Of Bulimia Nervosa.
Individuals May Restrict Intake, Skip Meals, And Eliminate Sweets And Fats With The Intention Of Losing Weight. This Behavior Is Followed By An Intense Over-Eating And Sense Of Guilt. The Individuals Then Proceed To Limit Their Eating Or Avoid Taking Insulin. The Vicious Cycle Repeats. The Intention For People With Diabulimia Is To Lose Weight, And Some May Demonstrate Weight Loss In A Period Of Time. However, The Erratic Eating Behavior Slows The Metabolism, And Lasting Weight Loss Seldom Occurs.
Discomfort Eating Around Other People
Because Of Their Irregular Eating Behavior, Individuals With Diabulimia Prefer Not To Eat Around Other People, Especially When They Have The Urge To Overeat. Even If They Sit With Their Family At The Dining Table, They Will Choose Foods With Fewer Calories And Eat Small Portions. Patricia Refused To Eat Breakfast With Her Family Or Lunch With Classmates, Yet As Soon As She Came Home From School She Ate A Big Bag Of Chips And A Half Dozen Cookies In Private.
Hoarding Food Without Insulin, Nutrients Cannot Get To The Cells. When The Cells Need Nutrients, The Individual Feels Hungry. To Satisfy Hunger, They Crave Food. But Patients With Diabulimia May Feel Guilty, Defeated, Or Ashamed When They Lose Control Over Their Hunger. Therefore, They May Hoard Foods And Eat Alone During Weak Moments.
Joyce's Parents Could Not Understand Why They Kept Finding Candy Bar Wrappers In Her Room When She Claimed That She Was On A Diet To Lose Weight.
Irregular Or Nonexistent Menses
High A1c Levels Have Been Reported To Cause Irregular Menses, Cessation Of Periods, And Delayed Puberty Due To Interference With The Function Of The Brain.16 Joyce Had Not Yet Started Her Menstruation Cycles At The Age Of 15, And Patricia Had Irregular Menses.
Unwillingness To Follow Through With Appointments
Fourteen-Year-Old Mary Cried Out For Help With Three DKA Episodes. On Her Third Visit To The Emergency Room, She Told The Doctors That She Had Not Been Taking Insulin At Home; She Needed Help And Wished To Be Admitted To The Hospital. She Was, And After Discharge, She Was Referred To An Endocrinologist And A Psychotherapist For Follow-Up Treatment. Her Pediatrician Also Referred Her To Me For Nutritional Counseling.
Her Parents Could Not Accept That Eating Disorders Might Have Played A Role In Mary's Diabetes. They Requested That The Endocrinologist Prescribe The "Right Dose" Of Insulin And Teach Her The "Correct Information." After The Initial Nutritional Evaluation, Her Parents Cancelled The Appointment With Me. "The Dietitian Didn't Really Fix Her Eating," Her Parents Said To Her Pediatrician. Mary's Parents Didn't Follow Through With Her Therapist Either. They Believed Mary's Problem Was Strictly Medical And Not Psychological.
I Can Only Imagine How Helpless And Hopeless Mary Must Have Felt. She Finally Got A Health Team's Attention, But Then Her Parents Could Not Support Her Treatment.
In Another Case, A Mother Recognized How Much Her 22-Year-Old Daughter, Susan, Was Struggling. She Saw Susan Curl Like A Ball In The Corner Of Her College Dorm Room When She Visited Her. Susan Was Tired And Nauseous Most Of The Time From Hyperglycemia. When Her Mother Checked, There Seemed To Be The Same Amount Of Insulin In The Fridge As There Was A Week Ago.
Susan's Mom Arranged Multiple Appointments For Her Daughter's Diabetes Care, But Susan Managed To Make One Excuse After Another And Cancelled The Appointments.
Due To The Unwillingness Of The Individuals To Get Well And The Lack Of Awareness And Information For The Families, Follow-Up Treatment For Diabulimia Is A Great Challenge.
Doubtful Blood Glucose Monitoring
If The Numbers Shown In Blood Glucose Meters Seem Too Good To Be True, They Are.
Patricia Informed Me That A Specific Proportion Of Water And Milk Substituted For Blood On The Test Strip Produced An Ideal Reading Of Blood Glucose Below 200mg/DL. That Was How She Convinced The Health Providers And Her Mother That She Checked Her Blood Glucose And That The Readings Were Fine. If Her Mother's Suspicions Were Raised By Those Almost Perfect Numbers, Patricia Then Mixed Juice With Water To Increase The Number Of The Reading.
In Both The Diabetes Clinic At Children's Hospital At Stanford And My Nutrition Counseling Private Practice Offices, I Observed The Feigned Forgetfulness Of Those Who Practiced Diabulimia. They Claimed They Forgot To Bring Their Meters; They Forgot To Enter Carbohydrates Consumed Onto Their Insulin Pump; Or They Forgot The Trend Of Their Blood Glucose. Either They Didn't Want Me To Know The Truth, Or They Didn't Think I Could Handle The Truth. Yet The Truth Was That They Were Taking Less Than Their Prescribed Insulin And Managing Their Diabetes Poorly.
There Have Been Few Studies Conducted To Determine Treatments For Diabulimia.
The Following Are What I Have Compiled From A Few Articles, From Talking To Health Professionals, And (Chiefly) Through My Own Experiences.
Proposed Treatment Plans For Diabulimia
Inpatient Treatment
Some Individuals Require Hospitalization To Achieve Metabolic Control. Those With Symptoms Of Complications May Also Need Inpatient Treatment.
Multi-Disciplinary Team Approach
If Hospitalization Is Not Yet Necessary, Individuals With Diabulimia Should Be Followed By A Team Of Experts. For Successful Treatment Of The Multi-Faceted Symptoms And Behavior Of Diabulimia, A Multi-Disciplinary Team Approach Is Crucial. This Team Should Include:
| | An Endocrinologist Who Is Sensitive To The Psychosocial Component Of Individuals |
| | A Psychotherapist Experienced With Both Chronic Illness And Eating Disorders |
| | A Registered Dietitian Who Is Passionate About Eating Disorders And, More Importantly, Skillful In Mastering The Management Of Blood Glucose Patterns And Insulin Regimens |
In My Practice, I Follow Clients With Diabulimia Every Other Week For Nutritional Education. I Also Request That They Visit Their Endocrinologists Or Nurse Practitioners Monthly And Their Therapists At Least Once A Week.
Develop Healthy Eating Habits
Helping Individuals To Develop Healthy Eating Behavior Is The Foundation Of Medical Nutrition Therapy For Diabulimia. For Those Who Are Overweight, I Work With Them On Proper Portions; High Nutrients, And Low Caloric Food Choices; A Good Breakfast; Healthy Snacks; A Realistic Meal Schedule; And Simple Recipes For Homemade Meals. They Make Steady Weight Loss Progress By Improving Their Lifestyle.
Shift Focus Away From Weight
For Those Who Are Obsessed About Body Weight, Refraining From Weighing Themselves Is The Best Approach. At The Lucille Packard Children's Hospital @ Stanford (LPCH) Diabetes Clinic, Patients Have The Choice Of Not Knowing Their Weight. In My Offices I Have Clients Look Away From The Scale When I Weigh Them.
Promote Appropriate Exercise
With The Exception Of Patients Diagnosed With Anorexia Nervosa, Who Are Underweight, Who Have Unstable Vital Signs, Or Who Exhibit Compulsive Exercise Behavior, Appropriate Physical Activities Can Be Usefully Integrated Into The Diabulimia Treatment Plan.
Find Motivators: Everyone Has Something Important To Them
Success In Helping Individuals Make Progress Depends On Learning What Motivates Them. There Is Always Something Important To Someone; It's Up To Clinicians And Families To Find It. You Might Motivate Them By Explaining They Could:
Develop Healthy Eating Habits
Helping Individuals To Develop Healthy Eating Behavior Is The Foundation Of Medical Nutrition Therapy For Diabulimia. For Those Who Are Overweight, I Work With Them On Proper Portions; High Nutrients, And Low Caloric Food Choices; A Good Breakfast; Healthy Snacks; A Realistic Meal Schedule; And Simple Recipes For Homemade Meals. They Make Steady Weight Loss Progress By Improving Their Lifestyle.
Shift Focus Away From Weight
For Those Who Are Obsessed About Body Weight, Refraining From Weighing Themselves Is The Best Approach. At The Lucille Packard Children's Hospital @ Stanford (LPCH) Diabetes Clinic, Patients Have The Choice Of Not Knowing Their Weight. In My Offices I Have Clients Look Away From The Scale When I Weigh Them.
Promote Appropriate Exercise
With The Exception Of Patients Diagnosed With Anorexia Nervosa, Who Are Underweight, Who Have Unstable Vital Signs, Or Who Exhibit Compulsive Exercise Behavior, Appropriate Physical Activities Can Be Usefully Integrated Into The Diabulimia Treatment Plan.
Find Motivators: Everyone Has Something Important To Them
Success In Helping Individuals Make Progress Depends On Learning What Motivates Them. There Is Always Something Important To Someone; It's Up To Clinicians And Families To Find It. You Might Motivate Them By Explaining They Could:
a. Decrease Tiredness, Headache, Or Nausea And Thus Be Able To Better Concentrate At School Or In The Workplace
b. Decrease Thirst, Frequent Drinking, Or Bathroom Trips, And Thus Be Able To Socialize
c. Maintain Muscle Mass And Energy To Keep Up With Sports Performance
d. Have Less Intermittent Blurred Vision
e. Reduce The Symptoms Of Painful Neuropathy
One Might Think That Preventing Limb Amputation, Blindness, Renal Dialysis, Or Death Would Be Good Motivators. However, Most Teenagers And Young Adults Don't Seem To Think That Could Happen To Them; It's Just Too Far Away. Immediate Gratification And Consequences Seem To Work Much Better.
Educate Persistently
When I Started Working With The Eating Disorders Program At Lucille Packard Children's Hospital Over 20 Years Ago, I Was Not Sure If Any Of The Information I Provided Really Helped. Most Of My Patients Claimed That They Read More Nutrition Books Than I Did, And They Selectively Believed Information Acquired From Friends, The Internet, Or Magazines. Soon I Learned That Resilience Is The Key To Educating This Population. It's Like Putting Nickels In A Slot Machine; In Order To Get The Jackpot, One Can't Give Up.
And Yes, I Have Been Depositing Rolls And Rolls Of Nickels To Help My Diabulimia Patients. I Pick A Subject At Each Visit, Such As Blood Sugar Monitoring, Metabolic Blood Glucose Control, Healthy Lifestyle, Or Short-Term And Long-Term Complications Of Hyperglycemia. I Simply Provide Education Without Judgment, Without A Sales Pitch, And Without Scary Tactics.
Set Small Goals
It's Overwhelming For Those Who Have Diabulimia When Healthcare Providers Or Caretakers Expect Them To Accept The Full Amount Of Insulin Prescribed. The Less Insulin They Took, The Higher Their A1c Would Be. Thus, They Would Be Prescribed More Insulin At The Next Visit To The Doctor. Therefore, The Gap Between What Was Prescribed And What Was Taken Actually Widened.
Source: Http://Www.Edreferral.Com
Educate Persistently
When I Started Working With The Eating Disorders Program At Lucille Packard Children's Hospital Over 20 Years Ago, I Was Not Sure If Any Of The Information I Provided Really Helped. Most Of My Patients Claimed That They Read More Nutrition Books Than I Did, And They Selectively Believed Information Acquired From Friends, The Internet, Or Magazines. Soon I Learned That Resilience Is The Key To Educating This Population. It's Like Putting Nickels In A Slot Machine; In Order To Get The Jackpot, One Can't Give Up.
And Yes, I Have Been Depositing Rolls And Rolls Of Nickels To Help My Diabulimia Patients. I Pick A Subject At Each Visit, Such As Blood Sugar Monitoring, Metabolic Blood Glucose Control, Healthy Lifestyle, Or Short-Term And Long-Term Complications Of Hyperglycemia. I Simply Provide Education Without Judgment, Without A Sales Pitch, And Without Scary Tactics.
Set Small Goals
It's Overwhelming For Those Who Have Diabulimia When Healthcare Providers Or Caretakers Expect Them To Accept The Full Amount Of Insulin Prescribed. The Less Insulin They Took, The Higher Their A1c Would Be. Thus, They Would Be Prescribed More Insulin At The Next Visit To The Doctor. Therefore, The Gap Between What Was Prescribed And What Was Taken Actually Widened.
Source: Http://Www.Edreferral.Com
Anorexia And Hypnotherapy
There Are A Number Of Different Methods Of Therapy That A Professional Doctor May Use To Treat Anorexia. Due To The Fact That Anorexia Is An Illness That Doesn’t Necessarily Have A Set Treatment Or Cure, Many Different Types Of Treatment Are Generally Administered To See Which One Is Effective. Hypnotherapy Is A New Treatment That Has Come To Treat A Number Of Different Medical Conditions, One Of Them Being Anorexia. Hypnotherapy Will Use A Process Known As Hypnosis In Order To Change The Mentality Of Patients About Anorexia. Anorexia Can Be Very Dangerous If It Is Not Treated Soon Enough. Hypnosis Will Not Have A Lasting Negative Effect So It Should Be Tried If You Have Been Unsuccessful At Finding A Cure As Of Yet. This Article Will Provide You With Some Basic Information To Begin Using Hypnosis As A Form Of Treatment For Your Anorexia.
First You Will Need To Find A Professional Licensed Physician That Provides Hypnotherapy Often Known As A Hypnotherapist. Hypnosis Might Also Be Provided From A Psychotherapist Who Is A Medical Professional Whose Main Focus May Be Eating Disorder Treatments. Just Be Sure That You Are Aware Of What Is Expected From The Average Person Through Hypnotherapy. When The Average Person Undergoes Hypnosis, Your Medical Physician Should Give You Tips Through Encouraging You With Positive Words To Help You Become Better Acquainted With Eating And Food. Being Better Acquainted With Eating Through Hypnosis Will Help You To Be Less Opposed To The Consumption Of It. Your Body Will Start Accepting The Food Better Into The Body Through This Form Of Hypnotherapy. This Way You Will Be On Your Path Towards Living A Healthier Lifestyle Far Away From Anorexia.
Be Sure To Focus During Your Hypnotherapy Sessions Because Each One Can Be A Potential Drastic Change Of Your Mentality And Health. Try Your Best Not To Think Of Any Outside Distractions When You Are Entering Your State Of Hypnosis. Your Hypnotherapist Will Be Your Guide To Help You Relax By Using A Few Different Methods. Once You Are Feeling As If The Hypnosis Has Put You In A Trance That Means It Is Working. Be Prepared To Enter A Few Hypnotherapy Sessions In Order To See Any Results. If You Believe That You Would Rather Perform Hypnosis On Yourself At Home You Can Learn To Do So From Your Medical Physician As Well. You Should Try Working With Your Medical Physician And Continue With Several Hypnotherapy Sessions To See How Effective It Can Be. Once You Feel That You Are Comfortable Enough To Enter A State Of Hypnosis On Your Own Without Any Help You Can Try To Learn It Slowly. You Must Remember That Anorexia Is A Continuous Battle That Many People Continue To Accompany Them Throughout Their Whole Life. Even With These Hypnotherapy Sessions Where Your Mind Becomes Better With Dealing With Anorexia Through Hypnosis, You Must Be Patient And Persistent With The Battle. That Will Be The Only Way For You To Fully Recover And Beat The Battle Against Anorexia Through Hypnotherapy.
Source: Www.Hypnotherapist.Org
On The Teen Scene:
Eating Disorders Require Medical Attention
Eating Disorders Require Medical Attention
By Dixie Farley
For Reasons That Are Unclear, Some People--Mainly Young Women--Develop Potentially Life-Threatening Eating Disorders Called Bulimia Nervosa And Anorexia Nervosa. People With Bulimia, Known As Bulimics, Indulge In Bingeing (Episodes Of Eating Large Amounts Of Food) And Purging (Getting Rid Of The Food By Vomiting Or Using Laxatives). People With Anorexia, Whom Doctors Sometimes Call Anorectics, Severely Limit Their Food Intake. About Half Of Them Also Have Bulimia Symptoms.
The National Center For Health Statistics Estimates That About 9,000 People Admitted To Hospitals Were Diagnosed With Bulimia In 1994, The Latest Year For Which Statistics Are Available, And About 8,000 Were Diagnosed With Anorexia. Studies Indicate That By Their First Year Of College, 4.5 To 18 Percent Of Women And 0.4 Percent Of Men Have A History Of Bulimia And That As Many As 1 In 100 Females Between The Ages Of 12 And 18 Have Anorexia.
Males Account For Only 5 To 10 Percent Of Bulimia And Anorexia Cases. While People Of All Races Develop The Disorders, The Vast Majority Of Those Diagnosed Are White.
Most People Find It Difficult To Stop Their Bulimic Or Anorectic Behavior Without Professional Help. If Untreated, The Disorders May Become Chronic And Lead To Severe Health Problems, Even Death. Antidepressants Are Sometimes Prescribed For People With These Eating Disorders, And, In November 1996, FDA Added The Treatment Of Bulimia To The Indications For The Antidepressant Prozac (Fluoxetine).
About 1,000 Women Die Of Anorexia Each Year, According To The American Anorexia/Bulimia Association. More Specific Statistics From The National Center For Health Statistics Show That "Anorexia" Or "Anorexia Nervosa" Was The Underlying Cause Of Death Noted On 101 Death Certificates In 1994, And Was Mentioned As One Of Multiple Causes Of Death On Another 2,657 Death Certificates. In The Same Year, Bulimia Was The Underlying Cause Of Death On Two Death Certificates And Mentioned As One Of Several Causes On 64 Others.
As To The Causes Of Bulimia And Anorexia, There Are Many Theories. One Is That Some Young Women Feel Abnormally Pressured To Be As Thin As The "Ideal" Portrayed By Magazines, Movies And Television. Another Is That Defects In Key Chemical Messengers In The Brain May Contribute To The Disorders' Development Or Persistence.
The Bulimia Secret
Once People Begin Bingeing And Purging, Usually In Conjunction With A Diet, The Cycle Easily Gets Out Of Control. While Cases Tend To Develop During The Teens Or Early 20s, Many Bulimics Successfully Hide Their Symptoms, Thereby Delaying Help Until They Reach Their 30s Or 40s. Several Years Ago, Actress Jane Fonda Revealed She Had Been A Secret Bulimic From Age 12 Until Her Recovery At 35. She Told Of Bingeing And Purging Up To 20 Times A Day.
Many People With Bulimia Maintain A Nearly Normal Weight. Though They Appear Healthy And Successful--"Perfectionists" At Whatever They Do--In Reality, They Have Low Self-Esteem And Are Often Depressed. They May Exhibit Other Compulsive Behaviors. For Example, One Physician Reports That A Third Of His Bulimia Patients Regularly Engage In Shoplifting And That A Quarter Of The Patients Have Suffered From Alcohol Abuse Or Addiction At Some Point In Their Lives.
While Normal Food Intake For Women And Teenagers Is 2,000 To 3,000 Calories In A Day, Bulimic Binges Average About 3,400 Calories In 1 1/4 Hours, According To One Study. Some Bulimics Consume Up To 20,000 Calories In Binges Lasting As Long As Eight Hours. Some Spend $50 Or More A Day On Food And May Resort To Stealing Food Or Money To Support Their Obsession.
To Lose The Weight Gained During A Binge, Bulimics Begin Purging By Vomiting (By Self-Induced Gagging Or With An Emetic, A Substance That Causes Vomiting) Or By Using Laxatives (50 To 100 Tablets At A Time), Diuretics (Drugs That Increase Urination), Or Enemas. Between Binges, They May Fast Or Exercise Excessively.
Extreme Purging Rapidly Upsets The Body's Balance Of Sodium, Potassium, And Other Chemicals. This Can Cause Fatigue, Seizures, Irregular Heartbeat, And Thinner Bones. Repeated Vomiting Can Damage The Stomach And Esophagus (The Tube That Carries Food To The Stomach), Make The Gums Recede, And Erode Tooth Enamel. (Some Patients Need All Their Teeth Pulled Prematurely). Other Effects Include Various Skin Rashes, Broken Blood Vessels In The Face, And Irregular Menstrual Cycles.
Complexities Of Anorexia
While Anorexia Most Commonly Begins In The Teens, It Can Start At Any Age And Has Been Reported From Age 5 To 60. Incidence Among 8- To 11-Year-Olds Is Said To Be Increasing.
Anorexia May Be A Single, Limited Episode With Large Weight Loss Within A Few Months Followed By Recovery. Or It May Develop Gradually And Persist For Years. The Illness May Go Back And Forth Between Getting Better And Getting Worse. Or It May Steadily Get More Severe.
Anorectics May Exercise Excessively. Their Preoccupation With Food Usually Prompts Habits Such As Moving Food About On The Plate And Cutting It Into Tiny Pieces To Prolong Eating, And Not Eating With The Family.
Obsessed With Weight Loss And Fear Of Becoming Fat, Anorectics See Normal Folds Of Flesh As "Fat" That Must Be Eliminated. When The Normal Fat Padding Is Lost, Sitting Or Lying Down Brings Discomfort Not Rest, Making Sleep Difficult. As The Disorder Continues, Victims May Become Isolated And Withdraw From Friends And Family.
The Body Responds To Starvation By Slowing Or Stopping Certain Bodily Processes. Blood Pressure Falls, Breathing Rate Slows, Menstruation Ceases (Or, In Girls In Their Early Teens, Never Begins), And Activity Of The Thyroid Gland (Which Regulates Growth) Diminishes. Skin Becomes Dry, And Hair And Nails Become Brittle. Lightheadedness, Cold Intolerance, Constipation, And Joint Swelling Are Other Symptoms. Reduced Fat Causes The Body Temperature To Fall. Soft Hair Called Lanugo Forms On The Skin For Warmth. Body Chemicals May Get So Imbalanced That Heart Failure Occurs.
Anorectics Who Additionally Binge And Purge Impair Their Health Even Further. The Late Recording Artist Karen Carpenter, An Anorectic Who Used Syrup Of Ipecac To Induce Vomiting, Died After Buildup Of The Drug Irreversibly Damaged Her Heart.
Getting Help
Early Treatment Is Vital. As Either Disorder Becomes More Entrenched, Its Damage Becomes Less Reversible.
Usually, The Family Is Asked To Help In The Treatment, Which May Include Psychotherapy, Nutrition Counseling, Behavior Modification, And Self-Help Groups. Therapy Often Lasts A Year Or More--On An Outpatient Basis Unless Life-Threatening Physical Symptoms Or Severe Psychological Problems Require Hospitalization. If There Is Deterioration Or No Response To Therapy, The Patient (Or Parent Or Other Advocate) May Want To Talk To The Health Professional About The Plan Of Treatment.
There Are No Drugs Approved Specifically For Bulimia Or Anorexia, But Several, Including Some Antidepressants, Are Being Investigated For This Use.
If You Think A Friend Or Family Member Has Bulimia Or Anorexia, Point Out In A Caring, Nonjudgmental Way The Behavior You Have Observed And Encourage The Person To Get Medical Help. If You Think You Have Bulimia Or Anorexia, Remember That You Are Not Alone And That This Is A Health Problem That Requires Professional Help. As A First Step, Talk To Your Parents, Family Doctor, Religious Counselor, Or School Counselor Or Nurse.
Dixie Farley Is A Staff Writer For FDA Consumer.
DISORDERS' DEFINITIONS
According To The American Psychiatric Association, A Person Diagnosed As Bulimic Or Anorectic Must Have All Of That Disorder's Specific Symptoms:
Bulimia Nervosa
· Recurrent Episodes Of Binge Eating (Minimum Average Of Two Binge-Eating Episodes A Week For At Least Three Months)
· A Feeling Of Lack Of Control Over Eating During The Binges
· Regular Use Of One Or More Of The Following To Prevent Weight Gain: Self-Induced Vomiting, Use Of Laxatives Or Diuretics, Strict Dieting Or Fasting, Or Vigorous Exercise
· Persistent Over-Concern With Body Shape And Weight.
Anorexia Nervosa
· Refusal To Maintain Weight That's Over The Lowest Weight Considered Normal For Age And Height
· Intense Fear Of Gaining Weight Or Becoming Fat, Even Though Underweight
· Distorted Body Image
· In Women, Three Consecutive Missed Menstrual Periods Without Pregnancy.
Source:www.Fda.Gov
Eating Disorders In Men
From Jerry Kennard, Former About.Com Guide
Eating Disorders Have Mostly Been Investigated Within The Female Population. To A Large Extent This Is Because Of The Apparent Prevalence Of Eating Disorders In Women. On Closer Inspection However Gender Distributions Of Eating Disorders Show About 10 Per Cent Of People With Anorexia Are Men.
Doctors Fail To Recognize Male Eating Disorders
To Date The Evidence Suggests That The Gender Bias Of Clinicians Mean That Diagnosing Either Bulimia Or Anorexia In Men Is Less Likely Despite Identical Behavior. Men Are More Likely To Be Diagnosed As Suffering Depression With Associated Appetite Changes Than Receive A Primary Diagnosis Of An Eating Disorder.
Eating Disorders And Occupation
There Are A Few Occupations In Which The Demand For Low Body Weights Can Lead To Anorexia Or Bulimia; Among Them Are Horse Racing, Modelling, Dancing, Distance Running And Driving.
Cultural, Social Issues And Eating Disorder
In Part, The Hidden Problem Of Eating Disorders In Men Is Cultural. Women Tend To Discuss Emotions And Psychological Problems More Than Men. Anorexia And Bulimia Are Perceived As A Woman's Problems. Discussion Of Weight Issues, Weight Control, Linking Thinness With Beauty Are Common Features In Women's Magazines And So Are Eating Disorders. Young Women Can Therefore Adopt The Same Behavior Without It Being Seen As Too Socially Unacceptable.
Little Recognition Male Eating Disorders
The Lack Of Visibility Of Anorexia Or Bulimia In The Male World Means A Number Of Things. Men Do Not Discuss Eating Disorders. Men Tend Not To Share The Information With Other Men Because The Subject Is A Female Issue. Men's Beauty Has To Do With Body Mass, Muscle Bulge And Definition, Not Weight Loss. This Male World, Socially Defined As Powerful And Masculine Results In Men Not Seeking Help Because Of Their Reluctance To Admit To The Problem.
Research Into Male Eating Disorders
A Large US Study Of Adolescents Reported In 1995 Does Show That Significant Numbers Of Young Males Experiencing Problem Weight Control Behavior.
2%-3% Of Males Diet All The Time Or More Than Ten Times A Year
5%-14% Of Males Deliberately Vomit After Eating
12%-21% Had A History Of Binge Eating
A Study Published In The April 2001 American Journal Of Psychiatry Found Many Psychological Similarities Between Men And Women With Eating Disorders, With Both Groups Experiencing Similar Symptoms.
Getting Help For Male Eating Problems
If You Are Experiencing Problems With Weight Control You Are Not Alone. Get Help By Contacting Your Family Doctor, A Psychologist, Mental Health Center Or A Doctor Specializing In Eating Disorders.
Article Sources Include:Woodside Et Al, D. Blake. "Comparisons Of Men With Full Or Partial Eating Disorders, Men Without Eating Disorders, And Women With Eating Disorders In The Community." American Journal Of Psychiatry (2001): 570.