A 7 year-old in Denver cries every night because she thinks she has the fattest thighs in her class. Hundreds of Esquire's readers report that they would rather get run over by a truck than be overweight. The media drown us with images of inhumanly thin women whose bodies have been stretched using computer graphics programs or created from the heads, thighs, and breasts of several women combined into one. Is it any wonder that eating disorders affect 7 million women and 1 million men in the US?
What Are Eating Disorders? Eating disorders include anorexia and bulimia nervosa and binge-eating disorder. People with anorexia starve themselves to dangerously thin levels, at least 15% below their appropriate weight. People with bulimia binge uncontrollably on large amounts of food-sometimes thousands of calories at a time-and then purge the calories out of their bodies through vomiting, starving, excessive exercise, laxatives, or other methods. People with binge-eating disorder eat uncontrollably, but they do not purge the calories.
Eating disorders are serious illnesses. The malnourishment of both anorexia and bulimia affects the body rapidly and can lead to hypoglycemia, pancreatitis, enlargement of the heart, heart attacks, congestive heart failure, permanent brain shrinkage with loss of memory and IQ, infertility, and osteoporosis. It is not uncommon for a teenage girl with anorexia to have the bones of an 80 year-old woman. The condition is not reversible. Ultimately, approximately 6% of people with anorexia and1% with bulimia will die from their eating disorder.
How Common Are They? Estimates indicate that 1/3 of American women and 15% of men will have an eating disorder or related problem at some time in their lives. 50 years ago, eating disorders were practically unheard of. So what happened?
What Causes Them? Research suggests a strong genetic component to eating disorders. People who are genetically prone to perfectionism and low self-esteem may be most at risk. But since the human genome has barely changed in the past 50 years, genes cannot explain the recent increase in eating disorders. Something in our modern environment has triggered our ancient genes. Most authorities believe that media influences form a significant part of this modern-day trigger. Media images have equated thinness with beauty, peer acceptance, sexual and financial success, self-esteem, morality, and health. The cultural pressures for young people to obtain and maintain super-thin bodies are extreme.
In this environment, thinness readily becomes a way of dealing with many emotional issues. The imagined antidote to the common problems of young people-such as low self-esteem, feelings of victimization or disempowerment, or an uncertain identity-is the perfect body. Unfortunately, the "solution" fails to correct the problem, and brings more problems of its own.
How Can They Be Treated? Because eating disorders are multi-faceted illnesses, treatment should occur by a team of providers, including a primary care physician, counselor, and dietitian. Sometimes a psychiatrist is needed. A thorough assessment helps to determine which of the following issues require attention:
1. Physiology: Biochemistry can be off balance due to genetics, starvation, or other factors. Proper nutrition is the first line of treatment. Medications may be needed to treat related conditions (e.g., hormone replacement therapy or anti-depressants).
2. Emotions: Many people with eating disorders use their disorder to regulate intense negative feelings such as anger, shame, and self-hatred. Emotion regulation skills, such as those in Dialectical Behavior Therapy, are excellent treatment tools.
3. Distorted Thoughts: Most people with eating disorders view their bodies inaccurately, placing inordinate value on appearance. Cognitive restructuring is essential to deal with their dysfunctional beliefs and thoughts.
4. Motivation: Work with eating disorder patients should be tailored to their motivational level, so that they are actively choosing treatment. Motivational Interviewing may be needed to assess motivation and to help patients actively embrace recovery.
5. Skills: Eating disorders are unhealthy, irrational ways of obtaining rational goals. One must validate the underlying needs that eating disorders serve-such as the needs for love and acceptance-while helping patients to understand that they have chosen destructive methods to meet these legitimate goals. Providers can teach new skills and tools through which patients may meet their needs more effectively.
6. Social Context: Because the environment can be unfriendly and difficult, patients must learn to deal with the environment more assertively and to protect themselves in healthier ways. Because some patients have been deeply wounded by others, it is important to begin the forgiveness process. Marital or family therapy may be needed to change the systemic relationship patterns that sustain eating disorders.
7. Spirituality: Patients must learn to take responsibility for their lives rather than continue in the victim role. It makes no sense to blame anyone for the eating disorder; it does make sense to emphasize personal responsibility for recovery. Also needed is a transformation from a worldview in which self-worth comes from appearance or achievement to one that values people as unique individuals. A person's faith often helps in this spiritual transformation.
Is Treatment Effective? Outcome studies suggest that treatment promotes adequate recovery in 75% of patients with eating disorders. Some treatment programs report even higher recovery rates. Recovery expectations have increased in the past 20 years, as the field learns more and improves its treatment methods. Overall, there is much hope for people with eating disorders.
If you or someone you know is struggling with an eating disorder, please call Remuda Programs for Eating Disorders at 1-800-445-1900.
