Eating disorders such as anorexia nervosa and bulimia are major health problems in our society, especially among young women. Anorexia and bulimia have certain similarities. There is a compulsive aspect to both diseases and both are self-destructive, endangering life. Both can be viewed as slow forms of suicide. They involve fear and guilt that lead to denial and an attempt to hide the evidence of the illness. Families are usually involved in an attempt to rescue the victims of the illness in a critical and punitive manner. Usually there are family histories of mood disorders.  Both diseases are strongly influenced by society's values and expectations.

Anorexia nervosa is a disorder in which loss of appetite and/or refusal to eat may lead to self starvation. The anorectic usually is a perfectionistic, achievement-oriented young woman 13 to 25 years of age who seeks to get control of her life by controlling her body. She feels this is the only area of her life over which she can maintain any control. The idea of becoming obese fills her with intense fear and disgust. Ironically, her distorted view of herself convinces her that she is obese even as emaciation threatens her health.

Bulimia is "recurrent episodes of solitary, secretive, binge eating where there is rapid consumption of large amounts of food in a short period of time, usually less than three hours." Bulimics have strong appetites and they can consume from 1,200 to 11,500 calories per episode. Binges occur most often in the late afternoon and into the evening and end with self-induced vomiting. The frequency of vomiting may vary from several times a day to less than once a week. The bulimic lives in constant fear of being discovered and often lies about the disappearance of food. Eventually, household members become suspicious and the bulimia is exposed. Laxatives, amphetamines, diuretics, fasting and excessive exercise are also used to avoid weight gain. Most bulimics maintain their weight although they weigh less than the norm for their age and height.

Typically, the bulimic is slightly older than the anorectic (usually 18 - 29 years of age), is more sociable and conforming and often appears to be the ideal student, career woman or wife. But, underneath this facade, she is acutely aware that her eating patterns are abnormal and fears not being able to voluntarily stop eating. She suffers from poor impulse control, fear of obesity, low self esteem and depression. Following a binge she usually experiences a depressed mood and self-condemning thoughts which can, and sometimes do, lead to suicide.

Anorectics frequently require hospitalization. However, for anorectics who are treated on an outpatient basis, one-to-one therapy which focuses on body image, feelings about weight gain, independence from family, control issues and excessive conformity is beneficial. Group therapy which focuses on exercise, assertiveness training and relationship building is also helpful. Family therapy dealing with communication patterns, control and independence issues provide an added benefit. Antidepressants may be given if their effect is closely monitored by a physician.

Therapy for the bulimic is usually on an outpatient basis. Its goals are to interrupt the binge/purge cycle by gaining control over eating and to change attitudes toward food, eating, body size and self. In an effort to gain control over food intake, it is helpful to  keep a record of everything eaten for a 24-hour period. Also record the times of day and the feelings associated with eating. This helps to form an accurate picture of food intake and the events that prompt eating. Develop a pattern of eating at specific times and places by eating only at designated mealtimes and only while sitting at the table. Calories should be distributed evenly throughout the day. Reduce the availability of food by keeping it stored in the kitchen rather than throughout the house. If you feel the urge to binge, distracting activities such as calling a friend, taking a walk or exercising can postpone eating. Certain foods are emotionally soothing, and bingeing on them can temporarily relieve unpleasant feelings such as anger and depression. Finding healthier ways to effectively cope with these feelings is an important goal of therapy. The goal of long-term therapy is to improve self esteem. This will give you strength and confidence to modify the binge/purge behavior.

Treating anorexia and bulimia can be difficult. A flexible, yet consistent program which includes the family can eliminate power struggles and bring rewarding results.

References:
Sanger, E., Cassion, T., & Potts, N. (1984, January) . American Journal of Nursing.  Vol. 84, No.1.  pp. 31-35.

©Copyright 1992, El Rophe Center, Inc.