Eating Disorders, Awareness on Rise
They could be called victims of the fitness boom, casualties of a siege to their self-esteem by a generation of flat stomachs, rippling muscles and glowing good looks.
They aspire to this sometimes impossible body ideal and, say psychiatrists and psychologists, turn away from--or toward--the one substance on which they believe their self-respect hinges: food.
The number of food abusers in the United States--those afflicted with anorexia nervosa, bulimia or the habit of binge eating--reflects a growing awareness about eating disorders and, according to psychiatrists and other health professionals, a new recognition of the symptoms.
Results of a nationwide Gallup poll released in November indicate that as many as one teen-age girl in eight may be afflicted with anorexia nervosa or bulimia. A total of 9% of girls between the ages of 13 and 18 believe that they have had symptoms of anorexia nervosa, an illness in which the victims deliberately starve away 20% or more of their body weight.
Another 5% think that they have had symptoms of bulimia, in which those afflicted go on food binges and then purge the food by self-induced vomiting or laxatives.
More than a third of teen-age boys and girls reported that they had gone on food binges at one time.
Food Binges
The poll also revealed that as many as a fourth of American women ages 19 to 39 periodically go on food binges, and one woman in 10 does so more than once a month (that figure includes 6% of women who go on such binges more than once a week).
To compensate for the binges, the survey found, almost half the women use some drastic measure such as strenuous exercise, fasting, laxatives or self-induced vomiting.
In all, the poll found that roughly 2 million young women have suffered from symptoms of anorexia nervosa or bulimia.
Are these figures unusually high? Experts in the eating disorders field say no.
“They’re not startling,” said Dr. Barton Blinder, a professor of psychiatry and director of the eating disorders unit at UC Irvine. “Probably about 8% of young women between 12 and 24 will experience some type of true eating disturbance. This has always been true. But the detection and the recognition of these problems is increasing.”
Experimental Behavior
Also increasing is what he called “experimental dieting behavior and binging-type experimental behavior” in which victims abandon conventional eating in favor of a type of eating (starvation, binging and purging, or just binging) that they think will raise their self-esteem or give them gratification. This behavior, Blinder said, is intentional and “quite different from rational eating.”
Bulimia, Blinder said, has existed for centuries, having been mentioned in the Talmud and recorded as a part of life in the ancient Roman empire. Anorexia nervosa, however, is a more modern affliction and has actually been on the increase in Western nations in the past decade, he said.
Dr. Abilio Hernandez, a psychiatrist specializing in the treatment of eating disorders who practices at the Brea Hospital Neuropsychiatric Center, said there was “no single reason for this phenomenon” but added that many young people’s preoccupation with food and the elusive body ideal has its roots in “the deterioration of the family. The family is no longer the place where children learn to control their impulses. They cannot delay gratification. Everything has to be now.”
Adolescents who have little or no guidance from parents who may be working, divorced or uncaring “haven’t solidified their own identities and they start to experiment with food,” Hernandez said. “Television does the parents’ job for them and gives children the ideals of what they should look like. They are bombarded with the idea of having a very fit body.”
At a recent conference on eating disorders held at the Irvine Marriott Hotel and sponsored by UCI Extension, Dr. Michael Strober, an associate professor and director of the teen-age eating disorder program at UCLA, said studies have shown that eating disorders actually run in families. If one family member is afflicted with anorexia or bulimia, he said, another family member is much more likely to contract the disorders. The transmission of the diseases, he said, can be social, environmental or, possibly, genetic.
Hernandez said he was “surprised” at the poll results that showed that 4% of teen-age boys claim to have had symptoms of anorexia or bulimia and that 40% say they have gone on eating binges.
“Many boys, even as young as 8 or 10 years old, will say they’re fat when they’re not. I think there has been a significant change in the number of boys who say they want to lose weight.”
Self Under Attack
Hernandez said he believes that “the problem will get worse. I don’t see society changing in this respect. It all has to do with the development of the self and we are seeing the self attacked in every way. People need to be not so preoccupied with what the external world wants.”
The eating disorder victim should “always seek professional help,” Hernandez said, “because the problem is more severe than they can handle.” If the disease is detected early, he added, there is a greater likelihood of an early and permanent cure.
Diagnosis and treatment of eating disorders are becoming more specialized and sophisticated, Blinder said. While there are a handful of proprietary hospitals in the Orange County area that treat patients with eating disorders, UCI is training what Blinder called “the first generation of residents in the specialty.”
New approaches to treatment, he said, are multidisciplinary and may include the use of diet and exercise therapy, psychoanalysis, behavioral conditioning and neurobiological drugs.
Eating disorders of any kind can present subtle symptoms and treatments can have varying rates of success, Blinder said.
Signs of Problem
“What we look for (in detecting a disorder),” he said, “are changes in eating habits and food selection. Also, there can be anxiety at the family table, shying away from eating meals with the family, more frequent conversations about body shape and size or complaining of unusual body experiences, like the arms feeling heavy. The person may withdraw from social eating situations and you might notice food missing from the cupboard or unusual amounts of money being spent on food.
“More grossly, there would be a visible change in body weight and stamina.”
With hospital and outpatient treatment, about 40 to 45% of anorexia victims can expect complete remission of the disease, Blinder said. About 25 to 30% improve and gain back weight, but “they’re what we call weight-recovered,” Blinder said, “and haven’t recovered as far as mental attitudes. They still worry and have unusual eating practices and attitudes.”
About 10 to 15% of anorexia sufferers become chronic cases, in which the disease continues to interfere with their development, and about 5% of patients die, Blinder said.
And, he added, among the 55% of anorexics who do not fully recover, there “doesn’t appear to be much hope” that they ever will fully recover.
Bulimics fare better, Blinder said, with a full recovery rate of about 75% in four years after hospitalization and outpatient treatment. Most patients, he said, make a full recovery by the time they enter their 40s.
Behavior Modification
Dr. Melissa Derfler, a second-year resident-in-training in the UCI department of psychiatry who spoke at the UCI-sponsored conference, said patients who enter the hospital with severe cases of anorexia often are treated through behavior modification.
“It’s almost Pavlovian conditioning,” she said. “You set up reinforcements for them that are contingent on their eating and gaining weight. It works marvelously and is practically foolproof.”
For the bulimic, she said, behavioral conditioning is used to “desensitize” the patient to certain foods.
“You might have the person handle a Big Mac,” she said. “It’s a phobic situation, but over a period of time they become desensitized. They can look at a chocolate cake and not feel a craving for it.”
However, she said, a program of psychotherapy always follows the conditioning in order to attack the mental root of the affliction.
Neurobiological drugs, which reduce cravings for specific foods, such as carbohydrates, are sometimes used, Derfler said, “but they’re still primarily in the experimental stage.”
Above all, Blinder said, the anorexic or bulimic person must be “treated as an individual. You treat them with individual psychotherapy and you work with their family. You can’t say: ‘Oh, you’re anorexic so you’re a high achiever and insecure about yourself and so on.’ Every case is different.”
