Does My Friend Have An Eating Disorder?

Q: My friend is constantly worried about her weight but she’s really skinny, she barely eats, she vomits often and seems very fragile and sickly to me. Does she have an eating disorder?

A: There could be many illnesses or diseases that cause sickness and weight loss so a physician should be contacted to ensure her health. However, key words used here is that she’s “constantly worried about her weight” which makes it very possible that she does have an eating disorder.  It is important to realize however, that these disorders are not about food. Eating disorders are a way of coping with symptoms of something much deeper that a person finds too painful or difficult to deal with directly but which no amount of dieting or weight loss will cure.

Eating disorders frequently coexist with other illnesses such as depression, substance abuse, or anxiety disorders and may also be a way of distancing yourself from difficult emotions. When you spend most of your time thinking about food, dieting, and weight loss, you don’t have to face other problems in your life or deal. Dieting and weight loss can’t repair the negative self-image at the heart of anorexia. The only way to do that is to identify the emotional need that self-starvation fulfills and find other ways to meet it.

Many people with anorexia nervosa see themselves as overweight, even when they are clearly underweight. Eating, food, dieting and your body become obsessions and can take over your life. Your desire to lose weight and worrying about how your body looks can become more important than anything else so eating and mealtimes can become very stressful. There becomes a persistent obsession of thinness and going to extremes to lose weight, but no matter how skinny you become, it’s never seems to be thin enough.

Anorexia can damage your health and even threaten your life. Anorexics have the highest mortality rate of all mental illnesses, with as high as 1 in 5 people with the illness eventually dying from complications.

There is cultural pressure to be thin, as well as family and social pressures that can contribute to anorexia and activities that demand slenderness, such as ballet, gymnastics, or modeling. Sometimes parents can be overly controlling and put a lot of emphasis on looks, dieting, or criticizing their children’s bodies and appearance. Eating disorders affects every race, culture, and socio-economic areas of society, as well as affecting both men and women.

Research suggests that a genetic predisposition to anorexia may run in families. If a girl has a sibling with anorexia, she is 10 to 20 times more likely than the general population to develop anorexia herself. Brain chemistry also plays a significant role. People with anorexia tend to have high levels of cortisol, the brain hormone most related to stress, along with lower levels of hormones that are associated with feeling good.

Eating disorders are also beginning at alarmingly young ages. Research suggests that almost half of the girls in grades 1 -3 want to be thinner, over 80% of 10-year-olds are afraid of being fat, and most kids with eating disorders developed their disordered between the ages of 11 and 13.

Types of eating disorders

The most common eating disorders are Anorexia, Bulimia, and Binge eating disorder.

Anorexia:

People with anorexia starve themselves out of an intense fear of becoming fat. Despite being underweight or even emaciated due to starvation, they never believe they’re thin enough

There are two types of anorexia. In the restricting type of anorexia, weight loss is achieved by restricting calories (following drastic diets, fasting, and exercising to excess). In the purging type of anorexia, weight loss is achieved by vomiting or using laxatives and diuretics.

Anorexia nervosa is a complex eating disorder with three key features:

·         refusal to maintain a healthy body weight

·         an intense fear of gaining weight

·         a distorted body image

Signs and Symptoms of Anorexia

·         Strange or secretive food rituals – Refusing to eat around others or in public places

·         Going to the bathroom right after meals

·         Making excuses to get out of eating

·         Feeling overweight despite dramatic weight loss or being underweight

·         Extreme preoccupation with body weight and shape

·         Terrified of gaining weight

·         Lie about how much you eat or hide your eating habits from others

·         Friends and  family are concerned about their weight loss, eating habits, or appearance

·         Constant dieting, even when thin

·         Fixation on body image, weight, body shape, or clothing size, frequently weigh themselves and concern over tiny fluctuations in weight.

·         Dieting to extremes, usually coupled with excessive or compulsive exercise or purging

·         Obsession with calories, food, or nutrition

·         Feel powerful or in control when they go without food, over-exercise, or purge

·         Base their self-worth on your weight or body size

·         Refusal to keep body weight at or above the normal weight for one's body type

·         Loss of menstrual periods

Effects of anorexia

Severe calorie restriction has very harmful effects to both your body and mind. When your body doesn’t get the proper amounts of energy and proper nutrients to function normally, it goes into starvation mode and slows down to conserve energy and nutrients needed to function. Your body will take care of itself as best it can by consuming fat and muscle mass to feed itself the energy it needs to survive. However, if a person continues to be undernourished, at a certain point vital functions and physical attributes slowly begin to malfunction and medical complications begin to occur affecting both physical and mental health.

Some of the physical effects of anorexia include:

·         Severe mood swings; depression

·         Lack of energy and weakness

·         Slowed thinking; poor memory

·         Dry, yellowish skin and brittle nails       

·         Hair gets thin and brittle

·         Low blood pressure, slowed heart rate, fluttering heart , heart failure

·         Anemia and other blood problems

·         Weak muscles, swollen joints, bone fractures, osteoporosis

·         Kidney stones, kidney failure

·         Girls period stops, bone loss, slow growth, difficulty getting pregnant, higher risk of miscarriage

·         Bruises easily, dry skin, gets cold easily, yellow skin, brittle nails

·         “Lanugo” hair, a soft hair that can grow all over the skin

·         Constipation and bloating

·         Tooth decay and gum damage

·         Dizziness, fainting, and headaches

·         Growth of fine hair all over the body and face

Bulimia Nervosa

Bulimia involves a destructive cycle of bingeing and purging. Following an episode of out of control binge eating, people with bulimia take drastic steps to purge themselves of the extra calories. This is usually done by self-induced vomiting, exercise, fasting, over use of laxatives, diet pills and diuretics.

Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight and some are slightly overweight. Yet, like people with anorexia nervosa, they usually fear weight gain, want desperately to lose weight, and are intensely unhappy with their body size and shape. Usually, bulimic behavior is done secretly because it is often accompanied by feelings of disgust or shame. The binge-eating and purging cycle happens anywhere from several times a week to many times a day.

Many of us eat when we feel a little stressed, lonely or bored and have a second helping. But when you suffer from bulimia, the craving to overeat becomes obsessive and you binge eat. What follows is that a bulimic person makes them self vomit, take laxatives, engage in long and intense exercise, fasting or, crash diets to get rid of the excessive calories that were consumed.  During an average binge, a person may consume as much as 3,000 to 5,000 calories in an hour.  This leaves the person feeling guilty and ashamed afterwards and more and more out of control but they can’t seem to control the urge. This vicious cycle of binging and purging is hard on your body and emotional well-being.  

It’s important to note that bulimia does not have to involve purging by throwing up. Compensating for binges by fasting, excessive exercising and crash diets also qualifies as bulimia.

Dieting is a strong trigger for bulimia’s destructive cycle of binging and purging. When you reduce your energy input your body reacts with cravings as a way of asking for the required nutrition and purging only reinforces binge eating. For every new diet you may tell yourself that this is the last time but a tiny voice in the back of your mind tells you that you can always throw up or use laxatives if you lose control again.

Purging does not prevent weight gain

Purging is not effective at getting rid of the unwanted calories from binging, so most people suffering with bulimia end up gaining weight over time. Vomiting immediately after eating eliminates maybe ½ of the calories or less from the food eaten because calorie absorption begins the moment you put food in the mouth. Laxatives only get rid of about 1/10 of the calories you’ve eaten, and diuretics only temporarily lower body fluid levels so they really do nothing at all.

Signs and symptoms of bulimia

Binge eating signs and symptoms

·         Lack of control over eating, the inability to stop eating or eating until the point of physical discomfort and pain

·         Eating secretly, perhaps  after everyone has gone to bed or going out alone on for food

·         Eating unusually large amounts of food with no obvious change in weight

·         Rarely eating normal meals, alternating between overeating and fasting

Purging signs and symptoms

·         Frequently disappears after meals or goes to the bathroom

·         Using laxatives, diuretics, or enemas after eating or taking diet pills to curb appetite

·         The bathroom or the person may smell like vomit and trying to cover up the smell with mouthwash, perfume, air freshener, gum, or mints.

·         Working out strenuously, especially after eating

Physical signs and symptoms of bulimia

·         Puffy “chipmunk” cheeks caused by repeated vomiting.

·         Discolored teeth from stomach acid when throwing up

·         Frequent fluctuations in weight due to alternating episodes of bingeing and purging.

Binge-eating disorder

Almost everyone overeats from time to time like taking an extra helping at Thanksgiving dinner, over eating a special food that is not served very often or at special occasions. But if over eating is a regular and uncontrollable habit, you may be suffering from binge eating disorder.

People with binge eating disorder compulsively overeat, rapidly consuming thousands of calories in a short period of time feeling out of control and powerless to stop. Despite feelings of guilt and shame over these secret binges, they feel unable to control their behavior or stop eating even when uncomfortably full. It is often triggered by chronic dieting and the need for comfort or to feel good.

Binge eaters use food to cope with stress and other negative emotions, but their compulsive overeating just makes them feel worse. Binge eating disorder is more common than anorexia and bulimia and affects a significant number of men as well as women.

The symptoms of binge eating disorder usually begin in late adolescence or early adulthood, often after a major diet. A binge eating episode typically lasts around two hours, but some people binge on and off all day long. Binge eaters often eat even when they’re not hungry and continue eating long after they’re full. They may also gorge themselves as fast as they can while barely registering what they’re eating or tasting.

People with binge eating disorder are embarrassed and ashamed of their eating habits, so they often try to hide their symptoms and eat in secret. Most binge eaters are overweight or obese, but many are of normal weight. They worry about what the compulsive eating will do to their bodies and beat themselves up for their lack of self-control. They desperately want to stop binge eating, but feel like they can’t.

People with binge eating disorder report more health issues, stress, insomnia, and suicidal thoughts than people without an eating disorder. Depression, anxiety, and substance abuse are common side effects as well. But the most prominent effect of binge eating disorder is weight gain.

Key features of binge eating disorder:

·         Frequent episodes of uncontrollable binge eating.

·         Feeling extremely distressed or upset during or after bingeing.

·         Unlike bulimia, there are no regular attempts to make up for the binges through vomiting, fasting, or over-exercising.

Treatment

It’s important to seek professional help early, follow through with treatment, and resolve the underlying emotional issues that caused the eating disorder in the first place.

People with an eating disorder usually work very hard to keep it secret, may have difficulty acknowledging there may be a problem or may deny a problem even exists. This can make diagnosis and therefore treatment difficult, since the symptoms of eating disorders also often occur in combination with depression, anxiety and substance abuse.

Typically therapy, nutritional counseling, and group support in combination seems to work best.  In some cases, residential treatment or hospitalization may be necessary.

Hospitalization may be required in extreme cases if the person is:

·         Dangerously malnourished

·         Severely depressed or suicidal

·         Suffering from medical complications

·         Getting worse despite treatment

Medical Treatment is the first priority in eating disorder treatment is addressing and stabilizing any serious health issues.

Counseling and therapy is very important for identifying and addressing negative thoughts and feelings that stimulate your eating disorder, changing dysfunctional beliefs about weight, dieting, and body shape as well as learning how to deal with difficulties in daily living and the stresses in constructive, rather than self-destructive ways.

Nutritional treatment: is needed for nutritional counseling for consuming enough calories to reach and maintain a normal, healthy weight.

How to help a person with an eating disorder:

·         Talk to the person about your concerns and respect their privacy but eating disorders should never be ignored.  Eating disorders can be a cry for help and they will appreciate knowing that you are concerned.

·         Offer compassion and support and listen without judgment and make sure the person knows you care.

·         Avoid shame, blame, or guilt, criticizing, accusations, insults, or scare tactics, because it only shuts down discussion and makes people defensive. Eating disorders are often a caused by stress, low self-esteem, and shame, negativity will only make it worse.

·         Avoid comments on how they look because they are already very aware of their body and compliments may only reinforce their obsession with body image and weight.

·          Focus on feelings specific behaviors and relationships, not on weight and food. Talk about why they feel or want to lose weight, explore their fears about being fat, and what they think they can achieve by being thin.

·         Set a good example for healthy eating, exercising, and body image. Don’t make negative comments about your own body or anyone else’s.

·         Take care of yourself. Worrying and caring for a person with eating disorders can be difficulty emotionally.

Accept your limits. You can’t force a person with an eating disorder to change but you can help by offering your compassion, encouragement, and support throughout the treatment process.

·         Encourage him or her to seek help. The longer an eating disorder remains undiagnosed and untreated, the more difficult it will be to overcome, so urge your loved one to see a health professional.