her first diet the same day she started attending high school.
She was a little chunky, but nothing that cutting back on lunchtime
candy and afterschool snacks wouldn't cure.
She felt good
after losing five pounds and thought she'd feel better if she
lost a few more. But Janet soon had a bigger problem when she
stopped eating completely. When she finally checked into a hospital
nine months later, she weighed 74 pounds. She still thought she
was too fat.
she is too fat, too. But she can't stop eating.
It starts when
her husband leaves for work. That's when Carol heads for the
refrigerator and wolfs down everything that looks good-and everything
sometimes looks good to her -- cookies, pop tarts, lunch meat,
leftovers. Afterwards, she races to the bathroom to throw it
all up. She often repeats the cycle in the afternoon.
Like a lot
of people, Janet and Carol don't want to get fat. But unlike
most of the rest of us, they're terrified of putting on pounds.
their problems eating disorders, triggered by an intense fear
of being fat which leads to uncontrollable eating habits.
that eating disorders may affect as many as 7 million young women
and a smaller number of men in America today. And sufferers who
fall into the trap of thinking they're fat when they're not risk
their health-and sometimes their lives -- to stay that way.
An eating disorder
can be cured, but only after it's identified for what it is.
The next step is doing something about it.
..What are eating disorders?
are patterns of dysfunctional belief and behavior that center
on diet and eating.
extreme habits and rituals. Sufferers may exercise exhaustively
and stick to impossibly strict diets. (When asked if she'd eaten
her breakfast, one anorectic patient replied: "Yes, I had
repeatedly throughout the day, counting and recounting calories
in a plate of food, or spitting food out without swallowing are
The most widespread
eating disorder is anorexia nervosa. Anorectics, like Janet,
lose weight by literally starving themselves.
-- too well. An estimated 6 percent of anorectics die of malnutrition
or disease brought on by refusing to eat.
known as the binge-purge syndrome, is a second major type of
eating disorder. Bulimics, like Carol, gorge themselves on large
amounts of food over a few hours, then force themselves to vomit
it back up again.
laxatives, enemas, or water pills (a group of drugs known as
diuretics) regularly to make sure they're not adding inches and
In severe cases,
bulimics may binge and purge as often as 10 times a day.
And to make
matters even more complicated, some sufferers are both anorectic
and bulimic, which doubles the difficulty of identifying and
treating the problem.
..What causes eating disorders?
to say. Because the fact is that there's no single, simple answer
to explain how and why anorexia and bulimia develop.
suspect that the disorders involve a complex web of factors,
with heredity and emotional conflict playing important roles
in both anorexia and bulimia. And increasingly, research has
focused on brain chemistry and the role of neurotransmitters
in the regulation of both appetite and self-image.
And we all
know how pervasive cultural influences can be, especially in
the media, and its narrow-profile definition of beauty.
reasons, people with eating disorders feel powerless. They tend
to be overachievers who deal with life's uncertainties and difficulties
by focusing on one thing they think they can control: their weight.
often see dieting as a form of personal control. Breaking a diet,
even to sip water or swallow a few bites, can seem a shattering
sign of weakness.
different, and are more likely to binge on food after a period
of dieting. Guilty and depressed about eating, they purge to
get rid of calories.
..What keeps the problem going?
and feelings of being out of control can work together to keep
eating disorders secret -- at least until major health problems
main problem involves a breakdown in self-image and the resulting
inability to see one's body as it really is.
eating disorders typically overestimate their body size by 25-50
in particular see themselves as being overweight, insisting that
they're still too heavy, even as they starve themselves.
..What turns a diet into a disorder?
easy answer to that question, either.
But since so
many people who develop eating disorders begin experiencing problems
during or shortly after puberty, some experts regard it is a
way of resolving inner conflicts about growing up.
first symptoms of anorectic or bulimic behavior surface during
a major life event (leaving home for college, for example) or
after a personal loss -- often by death or divorce -- or some
form of rejection, either real or imagined.
or binging and purging can seem to help ease the tension and
depression associated with sudden life changes.
After a while,
an eating disorder can virtually become a person's only coping
strategy for relieving negative feelings of anger, boredom, or
loneliness. Some bulimics even say they gorge in order to purge,
claiming it relaxes them.
..What are symptoms of an eating disorder?
The main physical
symptom of anorexia is obvious: serious and continuous weight
include dry skin and hair, cold hands and feet, weakness, constipation
and digestive problems, insomnia, and kidney and bladder infections.
As weight loss
progresses, anorectics usually become withdrawn and depressed
and serious health problems set in. Symptoms here can include
irregular heartbeat, high blood pressure, diabetes, anemia, and
more difficult to diagnose, since many are nearly normal in body
weight and can conceal their behavior, sometimes for years.
include weight changes, bloated face, blurred vision, kidney
and bladder infections, diabetes, and ulcers.
can involve side effects of drugs frequently used to produce
weight loss. Constant use of laxatives or diuretics can seriously
dehydrate the body and may rupture the stomach or throat.
bulimics are also more likely to exhibit other compulsive behaviors,
such as shoplifting, sexual promiscuity, and drug and alcohol
and bulimia can result in death. Luckily, things don't have to
go that far.
is that two important signs of eating disorders -- unexplained
stopping of menstruation and severe tooth decay-can be detected
by an alert physician or dentist.
can be helped along with the support of others who've been there
and know the way back, and by those who take the time to understand.
In recent years,
therapists and support groups have helped thousands who couldn't
control their eating habits learn to live (and eat) without guilt
or fear or compulsion.
hey now wake
in the morning without a sense of shame -- or the urgency to
lose more weight. They make friends and make goals happen --
little by little. Their lives may not be fairy tales, but in
a way they're better than fairy tales, because they're real and
they're under their own control -- for better or worse.
in small steps -- and it starts by learning how to think about
yourself and your life again. And the first step -- asking for
help -- is the only one you'll have to take alone.
it takes to get yourself well. Call a local counseling program
or mental health agency or simply confide in a friend, but make
today the day that you break free.
eating disorder is a serious problem.
It just doesn't
have to be your problem any more.
..Sidebar | Family
One fact about
eating disorders that's attracted serious interest in recent
years is the tendency of the problem to run in families.
No one yet
knows why, but the reason seems at least partly biological, according
In recent studies
involving twins, anorexia was discovered in 9 of 16 identical
twins of anorectic patients, but in only one in 14 fraternal
The odds of
bulimia also increase with genetic similarity. In another study,
the rate for identical twins with bulimia was 23 percent (eight
times that of the general public), 9 percent in fraternal twins
(three times the national average).
family connection will lead is anybody's guess at the moment.
Still, researchers hope it eventually leads to a better understanding
of the underlying causes of the diseases and improved biological
treatments -- if not an outright cure.
..Sidebar | Warning
Signs and Solutions
Step one in
overcoming an eating disorder is recognizing the problem. But
that can also be the hardest part of getting help, since eating
disorders can be kept secret, sometimes for years.
signs can serve to tip off anorectic or bulimic behavior, or
dangerous dieting habits that can signal the early stages of
an eating disorder. Critical signs include:
- Anorexia nervosa: Preoccupation with weight loss; refusal
to eat or extreme dieting; low self-esteem; loss of 25 percent
of body weight; menstrual irregularities; dental problems.
- Bulimia: Fear of weight gain; eating binges; vomiting
or heavy use of laxatives or diuretics; extreme dieting; menstrual
irregularities; dental problems.
Step #2 is
getting help for the problem. A combination of individual counseling
and behavioral therapy seems to work best, although severe cases
of anorexia may require temporary hospital care.
to a therapist in your area, contact: The American Anorexia/Bulimia
Association, 133 Cedar Lane, Teaneck, NJ 07666 (Their web address
is www.aabainc.org), or the National Association of Anorexia
Nervosa and Associated Disorders, Box 7, Highland Park, IL 60035
(www.anad.org). Their national hotline number is 847-831-3438.