BY DENA CABRERA

Eating disorders are epidemic throughout our country. They exist in big cities and small towns; and though they used to be relegated to a certain segment of the population, that is no longer the case. These days no one, regardless of age, ethnicity, culture or religion, is immune. Between 10 and 13 million people struggle with anorexia and bulimia. Yet, many people still believe that an eating disorder is just a diet that has gone a little too far, or simply a phase that a teenager goes through. It is important for everyone to understand what eating disorders really are, in order that they can recognize the warning signs in friends, family, adolescents and children. And make no mistake, today, even children as young as six years old are vulnerable to eating disorders.

The following is designed to help you understand more about these complex disorders and why they occur. Although anorexia and bulimia do present in the male population, they are far more prevalent among females, and therefore, is our focus.

ANOREXIA NERVOSA
If this psychiatric disorder had to be reduced to one word, it would be starvation. Those with anorexia starve themselves to dangerously thin levels, at least 15% of what would be considered a normal weight. Often, anorexia starts innocently enough: an adolescent or young woman wants to lose a few pounds, so she starts dieting. Unfortunately, she probably does not embark on a “smart” course of action: eat a little less, move a little more. Instead, influenced by the multi-billion-dollar diet industry, she opts for the latest fad diet that guarantees amazing results with very little effort. She starts the diet and probably loses weight fairly quickly; the fact that it is undoubtedly water weight isn’t the issue. She feels good about the results and even starts receiving compliments about how good she looks. So, she loses more and starts cutting out additional food groups, going far beyond what was even suggested by the original diet. No more meat, fats or carbohydrates. Eating anything white, such as flour or sugar, is definitely a thing of the past. The number on the scale continues to drop. Clothes become baggy – the compliments stop. She doesn’t even notice or care. After all, wasn’t weight loss the goal of the diet all along? Before she knows it, she is genuinely compulsive about the behavior.

What she doesn’t know is the tremendous damage she is doing to her body. The immediate medical consequences of anorexia include anemia, dry skin, mental confusion and severe hair loss. Although the scalp may go bald, unusual hair growth may occur on the torso. This is the body’s attempt to keep itself warm. The long-term medical consequences of anorexia include brain shrinkage, cardiac problems, bone loss and infertility. Often, these conditions are not reversible. Even worse is the high mortality and suicide rate of those with this disorder.

WHY WOULD ANYONE STARVE THEMSELVES TO DEATH?
Naturally, there is no one answer, indeed, the reasons are as varied as the individuals themselves. However, most experts believe the American media plays a key role in this problem by consistently reflecting our society’s obsession with thinness. Skinny celebrities, emaciated models are everywhere; and this thinness is equated with everything from peer acceptance and sexual appeal to financial success and self-esteem. The message is if a girl can just lose enough weight, she can, and will, have it all. Conversely, the American culture disdains fat. Surveys reveal that young girls would rather be anything but fat. This includes mean and stupid. Often, young girls would choose death over being fat.

With the message of “thin to win” constantly perpetuated in our society, and the overt rejection of fat, it really is no wonder that children, adolescents and young women fall victim to the allure of anorexia every single day. But here’s the good news: despite the profound influence of peers, television, movies, magazines and the Internet, parents can help prevent the advent of anorexia in the home. Mothers are particularly important because they serve as the primary role models for their daughters. If a mom places a huge stress on physical appearance in her own life, this can easily be passed on to her daughter. Sometimes, a daughter’s obsession with calorie counting and clothing size is a reflection of her mother’s attitudes and behavior. Fathers are also important because they are a daughter’s first, and often most significant, male relationship. It cannot be stressed enough how critical it is for fathers to focus on a daughter’s good qualities, instead of her physical appearance. What a profound difference it would make if girls could just grow up confident in the knowledge that what really mattered in life was who you are, not what you looked like.

BULIMIA NERVOSA
All eating disorders hold one thing in common: food. But whereas anorexia is defined by restriction, bulimia is characterized by bingeing and purging. Those with bulimia consume enormous amounts of food, often thousands of calories, in a short period of time. They eat much more than would be considered reasonable and far beyond the point of comfort. When they simply cannot consume any more, they purge the food, usually by vomiting. In addition, they often abuse laxatives, ingesting up to 200 laxatives a day. These behaviors are extremely hard on the body. The medical consequences of bulimia include injury to the esophagus, stomach and intestines as well as damage to the heart, lungs, kidneys and teeth. Although the mortality rate is not as high as anorexia, those with bulimia can die from medical complications related to their disorder.

Why would anyone willingly subject themselves to such a high consumption of food in tandem with the subsequent purging behavior?

Here’s why: bulimia, like many eating disorders, is not about food, it’s about feelings. Those who engage in bulimia do so as a form of emotional regulation, in effect, as a way to cope with unpleasant emotions. Consider this example: a young woman goes away to college, leaving home for the first time. Nothing is familiar, everything is foreign – a whole new environment, friends, academics, etc. She wants so desperately to do well, to make a success of her life. Her anxiety level is very high. She is homesick and scared. She notices that her stress level diminishes while eating; the food provides comfort, like an old friend. She consumes more than normal and worries about weight gain. She has heard talk around the dormitory that many students vomit after they eat to stay thin. She tries it and it works. Although she feels a certain amount of repugnance by the act of throwing up, she actually feels quite peaceful after doing so. Of course, what she doesn’t realize is such serenity is the result of endorphins flooding her bloodstream – the body’s attempt to soothe itself after vomiting. The next time she feels high anxiety, she copes by eating her favorite foods, without fear of gaining weight. This is often how it starts, and just as with anorexia, she becomes addicted to the behavior. Because after all, it works.

What people rarely realize at the outset of any eating disorder is how much it will eventually control their lives. In the case of bulimia, a great deal of effort inevitably goes into acquiring the food, planning the binge, ensuring the immediate environment is safe to not only eat all this food, but perform the ritualistic vomiting. It is all consuming. You see, bulimics don’t engage in this unhealthy behavior just occasionally; it is not unusual for the person to binge and purge a dozen or more times a day. That’s a lot of food and even more planning. When laxative abuse is involved, a whole new dimension enters the equation. It is not uncommon for a person to steal both food and laxatives, due to the cost involved. Another aspect that a bulimic rarely recognizes at the outset of the disorder is the profound shame, guilt and embarrassment she will ultimately experience. The absolute truth is that no one – not even an individual completely engaged in bulimia – can defend, or even really explain, her behavior. They often isolate, becoming more and more alone, and dependent on, the disorder. Unlike anorexics, who often like the way they look and are proud of their discipline, self-loathing is quite common for bulimics.

Anorexia and bulimia are extremely complex disorders. People who have never had an eating disorder are usually baffled by the very idea of them. Yet, those who are engaged in these behaviors absolutely know why they do them. What’s more, even if these individuals look terrible and feel even worse, they may find it nearly impossible to give the disorder up. This is why professional help is frequently required, especially if the disorder has been going on for a long period of time.

Eating Disorder Warning Signs
•    Weight loss: extreme thinness or loss of 15 or more lbs. in 2-3 months, is exhilarated by weight loss
•    Intense fear of being overweight: preoccupied with thinness, wants to be thinner than peers, complains of being overweight when not, obsessed with clothing size, scales, and mirrors
•    Preoccupation with dieting and food: uses diet products, talks constantly about food, calories, fat grams, reads a lot about nutrition, dieting, and exercise
•    Skips meals, eats very little, finicky about food, appears to eat when not – e.g., pushes food around on a plate but does not eat it
•    Unusual eating habits: eats one thing at a time, eats the same thing every day, cuts food into tiny pieces, fears touching certain foods, sudden vegetarianism, refuses to eat with others
•    Bathroom breaks: disappears into the bathroom during or after meals – may suggest vomiting to purge calories
•    Taking up smoking: especially for someone who would not be expected to smoke
•    Caffeine use: excessive drinking of diet caffeinated beverages or regular coffee without sugar
•    Evidence of binge-eating: A lot of empty food packages may suggest bingeing
•    Empty laxative packages: herbal or otherwise, may suggest purging
•    Onset of hyperactivity: constantly fidgets, lots of exercise
•    Loss of menstrual period: irregular, minimal, or absent menses
•    Intolerance of cold: shivering, blue skin or fingers
•    Wears baggy clothes or long sleeves, pants, and coats during summer months – used to hide excessive thinness, may indicate body image problems
•    Skin & hair problems: pasty-looking skin, very thin and dry hair, hair loss, and fine hair growth on the face and arms like a baby – all indicate malnourishment
•    Swollen salivary glands: distended, “chipmunk cheeks”
•    Broken blood vessels in the eyes
•    Change in mood: anxiety, depression, irritability, increased obsessions and compulsions
•    Social withdrawal: isolates from peers and family; unwilling to eat with other people
•    Perfectionism & low self-esteem: expects too much of self and sees self as not good enough

Dena Cabrera, Psy.D., is a licensed psychologist and has been on staff at Remuda Ranch Treatment Centers for 10 years. Dr. Cabrera is an expert in the psychodiagnostic assessment and treatment of eating disorders. She presents to national audiences on state-of-the-art treatments of eating disorders and difficult mental health problems. Dr. Cabrera has written numerous articles in journals and magazines and has appeared in several national media interviews.