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Because everyone today seems concerned about weight, and because most people diet at least once in a while, it is hard to tell what is normal behavior and what is a problem that may escalate to threaten life and happiness. No one person will show all of the characteristics listed below, but people with eating disorders will manifest several. In addition, the early stages of an eating disorder can be difficult to define. When does normative dieting become a health and emotional problem? When does concern about food and weight cross the line and become pathological? Answering these questions is hard, especially when our culture is very food and weight focused. Nevertheless, the questions are important. The sooner an eating disorder is treated, the easier it will be for the person to recover. If warning signs and symptoms are allowed to persist until they become entrenched behaviors, the person may struggle for years before s/he can turn matters around.
Definitions
- Anorexia nervosa
Bulimia nervosa Binge eating disorder (compulsive eating)
Anorexia athletic (compulsive exercising)
Bigarexia (or Muscle dysmorphia)
- How to Help Someone with an Eating Disorder
Checklist for Symptoms of Eating Disorders
Appearance and Body Image Behaviors
Exercise Behaviors
Thoughts
Feelings
Social Behaviors
Medical Problems
Psychological Problems
Important
Anorexia Nervosa: Dying to Be Thin
- Anorexia is usually defined as willful starvation--deliberate and obsessive starvation in the pursuit of thinness.
- Refusal to maintain normal body weight for age and height.
- Weight is 85% or less than what is expected for age and height.
- In women, menstrual periods stop. In men levels of sex hormones fall.
- Young girls do not begin to menstruate at the appropriate age.
- Denial of the dangers of low weight.
- Terrified of becoming fat.
- Terrified of gaining weight even though she is markedly underweight.
- Feeling fat even when very thin.
- In addition to the above, often there is depression, irritability, withdrawal, and peculiar behaviors such as compulsive rituals, strange eating habits, and division of foods into "good/safe" and "bad/dangerous" categories.
- You might expect to see: an extremely thin person; an overachiever; a perfectionist; an isolated individual; loneliness; black-white thinking; an obsessive preoccupation with food--obtaining, cooking, and eating; all- encompassing fatigue; extreme sensitivity to cold; compulsive exercise; distorted body image; and lack of menstrual period.
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Bulimia Nervosa: the Diet-Binge-Purge Disorder
- Bulimia is usually defined as a craving for food which often results in
overeating followed by purging--either by vomiting, laxatives, or exercise.
- Binge eating.
- Feel out of control while eating.
- Vomits, misuses laxatives, exercises, or fasts to get rid of the calories.
- Diets when not bingeing. Then becomes hungry and binges again.
- Belief that self-worth requires being thin.
- May shoplift, be promiscuous, and abuse alcohol, drugs, and credit cards.
- Weight may be normal or near normal unless anorexia is also present.
- Like anorexia, bulimia can kill. Though bulimics put up a cheerful front, they are often depressed, lonely, ashamed, and empty inside.
- Friends may describe them as competent and fun to be with, but underneath, where they hide their guilty secrets, they are hurting. Feeling unworthy, they have great difficulty talking about their feelings, which almost always include anxiety, depression, self-doubt, and deeply buried anger.
- You might expect to see: the use of food as a comforter; laxative or diuretic abuse; heart palpitations; mood swings; constant concern about body image and weight; quick trips to the bathroom after meals; dualistic thinking; excessive exercise; some isolation; low self-esteem; and average body weight.
Binge Eating Disorder: Sometimes Called Compulsive Eating
- Binge eating frequently and repeatedly.
- Feel out of control and unable to stop eating during binges.
- May eat rapidly and secretly, or may snack and nibble all day long.
- Feel guilty and ashamed of binge eating.
- History of diet failures.
- Tend to be depressed and overweight.
- People who have binge eating disorder do not regularly vomit, overexercise, or abuse laxatives like bulimics do. They may be genetically predisposed to weigh more than the cultural ideal (which present is exceedingly unrealistic), so they diet, make themselves hungry, and then binge in response to that hunger.
- Or, they may eat for emotional reasons: to comfort themselves, avoid threatening situations, and numb emotional pain. Regardless of the reason, diet programs are not the answer. In fact, diets almost always make matters worse.
Anorexia Athletica: Compulsive Exercising or Activity Anorexia
- The person repeatedly exercises beyond the requirements for good health.
- May be a fanatic about weight and diet.
- Steals time to exercise from work, school, and relationships.
- Focuses on challenge. Forgets that physical activity can be fun.
- Defines self-worth in terms of performance.
- Is rarely or never satisfied with athletic achievements.
- Does not savor victory. Pushes on to the next challenge immediately.
- Justifies excessive behavior by defining self as a "special" elite athlete.
- The real issues are not weight and performance excellence but rather power, control, and self-respect.
Who's at Risk for Anorexia or Bulimia?
- females, especially those in traditionally masculine cultures and certain
subcultures where weight is restricted--runners, dancers, etc.
- someone with early physical development
- someone who was overweight in childhood
- someone who needs social approval
- someone who has difficulty asserting needs
- someone with poor impulse control
- someone with a family history of substance abuse
- someone who has been sexually abused
- someone who engages in prolonged dieting
- someone with a high need for control
- someone with an obsessive need for perfection
Health Risks for Anorexia and Bulimia
Both forms of eating disorders are dangerous to good health and can cause major problems, both now and in the future. Some of the immediate physical complaints include constantly feeling cold, bloodshot eyes with dark circles, finger calluses, dizziness, weakness, lackluster hair, moodiness, insomnia, no menstruation, swollen glands, weight loss, sore throat, or dry skin. Some of the long-term effects include extreme weight loss, gastrointestinal pain, diarrhea and/or constipation, malnutrition, loss of tooth enamel, metabolism disruption, heart attack, electrolyte imbalance, permanent damage to internal organs, kidney failure, and death.
Both forms of eating disorders are dangerous to good health and can cause major problems, both now and in the future. Some of the immediate physical complaints include constantly feeling cold, bloodshot eyes with dark circles, finger calluses, dizziness, weakness, lackluster hair, moodiness, insomnia, no menstruation, swollen glands, weight loss, sore throat, or dry skin. Some of the long-term effects include extreme weight loss, gastrointestinal pain, diarrhea and/or constipation, malnutrition, loss of tooth enamel, metabolism disruption, heart attack, electrolyte imbalance, permanent damage to internal organs, kidney failure, and death.
Bigarexia: Body Dysmorphic Disorder
- Obsess about being small and undeveloped. Worry that they are too little, too frail, or underweight. (It is the opposite of anorexia.) They usually are muscle-bound, but believe their muscles are inadequate.
- Excessively concerned about appearance, body shape, body size, weight, perceived lack of muscles, facial blemishes, and other perceived body inadequacies and flaws.
- An unhealthy quest to become all-muscle, people with bigarexia get addicted to lifting weights, do resistance training and exercise compulsively.
- Feel deeply depressed after missing even one day of weight lifting.
- Many have well-developed musculature, but they are so obsessed with having the perfect physique that they look at their well-sculpted bodies in the mirror and see themselves as puny.
- Self-image can be so distorted — many admit to wearing baggy pants and sweatshirts to hide their "ugly bodies."
- In some cases it can lead to steroid abuse, unnecessary plastic surgery, and even suicide.
How to Help Someone with an Eating Disorder
If you suspect that a friend has an eating disorder, please remember that help is available at the Counseling Center. The following suggestions may also help you to help your friend.
DON'T:
If you suspect that a friend has an eating disorder, please remember that help is available at the Counseling Center. The following suggestions may also help you to help your friend.
DON'T:
- tell him/ her "You’re crazy."
- blame
- gossip about him/ her
- follow him/ her around to check her eating or purging behavior
- ignore him/ her
- reject him/ her
- tell him/ her to quit this ridiculous behavior
- feel you need to solve his/ her problem
- listen with understanding
- appreciate his/ her openness and the risk he/ she took to share
- support him/ her and be available
- give him/ her hope
- gently suggest counseling
Source: ANRED Anorexia Nervosa and Related Eating Disorders, Inc. Copyright 1998. All rights reserved.
Here are three suggestions:
- 1. Use "I" statements. ("I’m concerned about you because you refuse to eat breakfast or lunch." "It makes me afraid to hear you vomiting.")
2. Avoid accusational “You” statements ("You have to eat something!" "You must be crazy!" "You’re out of control!")
3. Avoid giving simple solutions. ("If you’d just stop, everything would be fine!")
consequences.
http://www.nationaleatingdisorders.org/, something-fishy.org,
mirror-mirror.org.eatdis.htm
Source: National Eating Disorders Associatoin, copyright 1998. All rights reserved.
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Checklist for Symptoms of Eating Disorders
YES/ NO
1. Do you feel society pressures you to be thin?
2. Do you feel you must be thin to be OK?
3. Are you preoccupied with food?
4. Do you feel guilty about eating?
5. Do you feel the need to be superior and perfect in academics, athletics and weight control?
6. Do you feel you weight is one of the few aspects of your life which you can control?
7. Do you diet excessively and/or abuse laxatives, diet pills or diuretics?
8. Do you feel you have become isolated from your family and friends?
9. Do you prefer eating alone?
10. Do you count all the calories hidden in every bite you eat?
11. Do you ever consume large amounts of food in a frenzy of hunger?
12. Do you ever induce vomiting after eating, particularly after a binge?
13. Do you exercise excessively?
14. Do you feel fat despite the fact that others tell you that you are thin or OK?
15. Does your weight fluctuate dramatically?
16. Have your menstrual periods ceased or become irregular?
17. Do you have trouble concentrating?
18. Do you often feel depressed and unhappy with yourself?
If you or someone you know answered "YES" to 5 or more of the above questions then you should be getting some help.
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Eating Disorder Food Behaviors
- The person skips meals, takes only tiny portions, will not eat in front of other people, eats in ritualistic ways, and mixes strange food combinations. May chew mouthfuls of food but spits them out before swallowing.
- Grocery shops and cooks for the entire household, but will not eat the tasty meals. Always has an excuse not to eat: is not hungry, just ate with a friend, is feeling ill, is upset, and so forth.
- Becomes "disgusted" with former favorite foods like red meat and desserts. Will eat only a few "safe" foods.
- Boasts about how healthy the meals s/he does consume are. Becomes a "vegetarian" but will not eat the necessary fats, oils, whole grains, and the denser fruits and veggies (such as sweet potatoes and avocados) required by true vegetarianism.
- Chooses primarily low-fat items with low levels of other nutrients, foods such as lettuce, tomatoes, sprouts, and so forth.
- Always has a diet soda in hand. Drastically reduces or completely eliminates fat intake.
- Reads food labels religiously. If s/he breaks self-imposed rigid discipline and eats normal or large portions, excuses self from the table to vomit and get rid of the calories.
- Or, in contrast to the above, the person gorges, usually in secret, and empties cupboards and refrigerator. May also buy special binge food.
- If panicked about weight gain, may engage in purging or other unhealthy behaviors to get rid of the calories.
- May abuse alcohol or street drugs, sometimes to deaden appetite, sometimes to escape emotional pain, and usually in hopes of feeling better, at least temporarily.
- The person loses, or tries to lose, weight. Has frantic fears of weight gain and obesity.
- Wears baggy clothes, sometimes in layers, to hide fat, hide emaciation, and stay warm. Obsesses about clothing size.
- Complains that s/he is fat even though others truthfully say this is not so. S/he will not believe them.
- Spends lots of time inspecting self in the mirror and usually finds something to criticize. Detests all or specific parts of the body, especially breasts, belly, thighs, and buttocks.
- Insists s/he cannot feel good about self unless s/he is thin, and s/he is never thin enough to satisfy her/himself.
Exercise Behaviors
- The person exercises excessively and compulsively.
- May tire easily, keeping up a harsh regimen only through sheer will power. As time passes, athletic performance suffers. Even so, s/he refuses to change the routine.
- May develop strange eating patterns, supposedly to enhance athletic performance. May consume sports drinks and supplements, but total calories are less than what an active lifestyle requires.
Thoughts
- In spite of average or above-average intelligence, the person thinks in magical and simplistic ways, for example, "If I am thinner, I will feel better about myself." S/he loses the ability to think logically, evaluate reality objectively, and admit and correct undesirable consequences of choices and actions.
- Becomes irrational, argues with people who try to help, and then withdraws, sulks, or throws a tantrum.
- Wanting to be special, s/he becomes competitive. Strives to be the best, the smallest, the thinnest, and so forth.
- Has trouble concentrating. Obsesses about food and weight and holds to rigid, perfectionistic standards for self and others.
Feelings
Social Behaviors
- Has trouble talking about feelings, especially anger. Denies anger, saying something like, "Everything is OK. I am just tired and stressed." Escapes stress by turning to binge food, exercise, or anorexic rituals.
- Becomes moody, irritable, cross, snappish, and touchy. Responds to confrontation and even low-intensity interactions with tears, tantrums, or withdrawal.
- Feels s/he does not fit in and therefore avoids friends and activities. Withdraws into self and feelings, becoming socially isolated.
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Social Behaviors
- Tries to please everyone and withdraws when this is not possible.
- Tries to take care of others when s/he is the person who needs care.
- May present self as needy and dependent or conversely as fiercely independent and rejecting of all attempts to help.
- Anorexics tend to avoid sexual activity. Bulimics may engage in casual or even promiscuous sex.
- Person tries to control what and where friends eat. To the dismay of others, s/he consistently selects low-fat, low-sugar non-threatening - and unappealing - foods and restaurants that in the past have provided these "safe" items.
- Relationships tend to be either superficial or dependent.
- Person craves true intimacy but at the same time is terrified of it.
- As in all other areas of life, anorexics tend to be rigidly controlling while bulimics have problems with lack of impulse control that can lead to rash and regrettable decisions about sex, money, stealing, commitments, careers, and all forms of social risk taking.
Medical Problems
- If not stopped, starving, stuffing, and purging can lead to irreversible physical damage and even death. Eating disorders can affect every cell, tissue, and organ in the body.
- The following is a partial list of the medical dangers associated with anorexia, bulimia, and binge eating disorder:
- -Irregular heartbeat, cardiac arrest, death
-Kidney damage
-Liver damage (made worse by substance abuse)
-Destruction of teeth
-Rupture of esophagus
-Loss of muscle mass
-Disruption of menstrual cycle, infertility
-Weakened immune system
-Icy hands and feet
-Swollen glands in neck
-stones in salivary duct
-"Chipmunk cheeks."
-Excess hair on face, arms, and body.
-Dry, blotchy skin that has an unhealthy gray or yellow cast
-Anemia, malnutrition
-Disruption of body's fluid/mineral balance
-Fainting spells
-Sleep disruption, bad dreams
-Mental fuzziness
-Permanent loss of bone mass, fractures and lifelong problems
- Binge eating disorder adds the following:
- -Increased risk of cardiovascular disease
-Increased risk of bowel, breast, and reproductive cancers
-Increased risk of diabetes
-Obesity can lead to arthritic damage to joints
Psychological Problems
- It is a sad paradox that the person who develops an eating disorder often began with a diet, believing that weight loss would lead to improved self-confidence, self-respect, and self-esteem. The cruel reality is that persistent undereating, binge eating, and purging have the opposite effect.
- Eating disordered individuals typically struggle with one or more of the following complications:
- -Depression that can lead to suicide
-Person feels out of control and helpless to do anything about problems.
-Anxiety, self-doubt
-Guilt and shame
-Hypervigilant. Suspects others of wanting to interfere
-Terrified of discovery
-Obsessive thoughts and preoccupations
-Compulsive behaviors. Rituals dictate most activities
-Feels alienated and lonely. "I don't fit in anywhere."
-Feels hopeless. May give up and sink into fatalism or denial.
Important:
- Eating disorders are treatable, and people do recover from them.
- The above complications, or threat of them developing, should encourage people to seek treatment, not give up and sink into despair. Sooner is better than later. The sooner treatment is begun, the sooner the person can develop personal strength and begin to create a life worth living.