Anorexia
The main signs and symptoms of anorexia include:
- Weight loss, sometimes severe
- Refusal to maintain body weight at or above a minimally normal weight
- Intense fear of gaining weight
- Disturbance in the body image you hold of yourself
- In women, menstrual changes or the absence of menstruation
Secondary signs and symptoms of anorexia may include:
- Fatigue
- Depression
- Anxiety
- Sleeplessness
- Avoiding other people
Bulimia
The main signs and symptoms of bulimia include:
- Recurrent episodes of binge eating
- Feeling that you can't control your eating behavior
- Eating much more food in a binge episode than in a normal meal or snack
- Following a binge by efforts to prevent weight gain — such as self-induced vomiting, using
laxatives or other medications, fasting or excessive exercise
- Unhealthy focus on your body shape and weight
Secondary signs and symptoms of bulimia may include:
- Cyclical weight loss and gain of more than 10 pounds
- Dehydration
- Fatigue
- Depression
- Anxiety
- Damaged teeth and gums from acid contained in vomit
- Swollen cheeks from regular vomiting
- Unexplained and persistent diarrhea
It's not easy to distinguish between an eating disorder and the whims and fads of adolescence. Binge eating, dieting and experimenting with vomiting to get rid of food aren't uncommon among teenage girls. These behaviors also occur, although not as frequently, among teenage boys. As a parent, be alert to sustained changes in dietary habits, not occasional quirks that are part of growing up.
Most teenage girls, and some teenage boys, go on diets to lose weight and stop dieting after 2 or 3 weeks. As a parent, be careful not to mistake occasional dieting with an eating disorder. The problem occurs when your child stops gaining weight during preadolescent years, when your child should be gaining 10 to 12 pounds a year during an active growth spurt.
Other signs that may indicate your child has a potential eating disorder:
- Not wanting to eat meals with the family.
- Frequent, long visits to the bathroom during or after meals. Your teenage child may run water to
obscure the sound of induced vomiting.
- Excessive exercise or preoccupation with weight.
- Wanting to be alone.
Doctors aren't sure of the exact causes of eating disorders. It appears that a variety of factors are involved, including genetics, family and culture. In some instances, the biological systems in the brain that govern mood and appetite develop abnormalities.
Part of the explanation may also be the messages that the media in modern, economically developed nations send to young people, particularly females. These messages are that excessive thinness is attractive. To be as thin as some teen idols and models are requires some people to achieve and maintain a weight that's not healthy for them. Although it's possible for some idols and models to be both thin and healthy, the trouble arises when some young people aren't able to sustain those body shapes without an unhealthy — for them — amount of weight suppression.
For some young people, the media message of thinness contributes to a distorted body image. A bright, high-achieving 14-year-old who is rational in every other way may come to believe that 90 pounds is the ideal weight for her 5-foot-4-inch frame. Gradually, she begins skipping meals, denying herself the fuel that her body needs to develop normally. She gets thinner and thinner but still believes she is fat. Eventually, she may become so undernourished that she needs to be admitted to the hospital for anorexia.
These factors may increase your risk of an eating disorder:
- Sex. Teenage girls and young women are more likely than teenage boys and young men to
develop eating disorders, though eating disorders do occur in teenage boys and young men.
- Age. Although eating disorders can occur in midlife, they are more common for people in
their teens and 20s.
- Family influences. People who feel less secure in their families, whose parents and
siblings may be overly critical, are at higher risk of eating disorders.
- Heredity. Eating disorders are more common in people who have close family members with
eating disorders.
- Emotional disorders. People with depression, anxiety disorders and obsessive-compulsive
disorder are more likely to also have an eating disorder. People with anorexia nervosa tend also to
have perfectionist traits. Some with bulimia have problems with impulse control.
- Excessive exercise. People who participate in highly competitive athletic activities are at
greater risk of developing an eating disorder. At particular risk of anorexia are females in sports
such as gymnastics, figure skating and track.
| When to seek medical advice |
If you have severe weight loss or if you find yourself alternating between binge eating and strict dieting, talk to your doctor to see if you have an eating disorder. Because denial often is a part of eating disorders, seeking medical advice may come only at the insistence of a family member or friend. If you notice the signs and symptoms of eating disorders in a family member or friend, urge that person to talk to a doctor.
Your doctor likely will perform a physical examination and ask you a number of questions about your eating habits and medical history. The questions your doctor asks may cover your history of dieting and binge eating, whether you self-induce vomiting or use laxatives, your exercise routine, how you perceive your body image, and how you think others perceive your body image. Your doctor will diagnose an eating disorder based on your symptoms and knowledge of your eating habits.
Besides recording your weight, a physical exam will help determine if you're suffering from any of the side effects of an eating disorder. These complications may include problems with your gums or teeth, bloating, unusual heart rhythms, loss of bone density, anemia and changes in your menstrual cycle. Your doctor may order these tests:
- Complete blood count (cbc). This blood test measures the amount of hemoglobin in your
blood. Hemoglobin is the red, iron-rich substance that binds to oxygen to carry it throughout your
bloodstream. The test also determines the percentages of your blood that are made up of red blood
cells, white blood cells and platelets. The test can signal the presence of a wide variety of health
problems, including anemia.
- Electrocardiogram. This procedure measures the pattern of electrical impulses generated in
your heart. The test can help identify heart damage and irregular heart rhythms. The procedure
involves attaching electrodes to your skin on your chest. The electrodes detect electrical impulses,
and the impulses are recorded on a graph.
- Chest X-ray. An image of your heart generated by an X-ray may reveal whether anorexia has
damaged your heart muscles by reducing the size of your heart.
- Other imaging tests. Tests such as a computerized tomography (CT) scan may reveal damage to
your brain or digestive tract.
- Bone density test. Your doctor uses a device called a sonometer to pass painless sound
waves through your bones to measure bone density.
- Tests of the function of your liver, kidney, thyroid, pituitary gland and ovaries. Your
doctor may order more extensive blood tests to detect your blood levels of hormones, enzymes,
proteins, electrolytes, vitamins and other substances to gauge the performance of various organs.
People with anorexia have a greater variety of health complications and a greater risk of death than do people with bulimia. However, both eating disorders can result in serious health problems.
Anorexia
The most serious health risk from anorexia is death, either because of severe weight loss or by suicide. Other problems include:
- Heart disease. Anorexia can cause irregular heart rhythms and result in smaller heart
muscles. Heart disease is a common cause of death for people with anorexia.
- Hormonal changes. Changes in reproductive hormones and in thyroid hormones can cause
absence of menstruation (amenorrhea), infertility, bone loss and retarded growth.
- Imbalance of minerals and electrolytes. Your body needs adequate levels of minerals,
particularly calcium and potassium, in order to maintain the electric currents that keep your heart
beating. Disruption of your body's levels of fluids and minerals creates an electrolyte imbalance.
Unless restored, this imbalance can be life-threatening.
- Nerve damage. Anorexia may cause brain and nerve damage, seizures and loss of feeling.
- Blood disorders. Lack of nutrition can reduce your body's levels of vitamin B-12, causing
anemia and affecting your body's ability to produce enough red blood cells.
- Digestive problems. Anorexia can cause constipation and bloating.
Bulimia
The related health problems aren't as severe for bulimia, partly because most people with bulimia maintain a normal weight. Complications may include:
- Teeth and gum problems. The presence of gastric acid in your mouth from regular vomiting
may cause damage to your teeth and gums.
- Bloating. Bulimic behavior can result in your body retaining more water.
- Low potassium levels. The purging process tends to make your body dehydrated and to lower
the level of potassium in your blood. This can cause weakness and irregular heart rhythms.
- Digestive problems. Purging may cause irritation of the walls of your esophagus and rectum.
- Behavioral and emotional problems. Bulimia may lead to depression and a variety of
impulsive behaviors, such as sexual promiscuity, stealing, alcohol abuse and drug abuse.
- Abuse of medications. The variety of over-the-counter drugs you may use during purge cycles
may cause a drug dependency. These include laxatives, diuretics, appetite suppressants and ipecac, a
drug that induces vomiting.
Severe cases of anorexia may require immediate hospitalization in order to rehydrate your body and restore your electrolyte balance.
For anorexia, your doctor or a nutritionist will want to set you on a course to gradually gain weight. To treat either anorexia or bulimia, your doctor likely will recommend nutrition education, psychotherapy and family counseling. Your doctor may also prescribe medications to reduce bingeing, vomiting and preoccupation with food or to treat the depression and anxiety that may be associated with eating disorders.
- Nutrition education. Your doctor or nutritionist may discuss with you the establishment of
a routine for meals and the importance of a healthy diet.
- Psychotherapy. Your therapist may suggest cognitive behavior therapy. This approach is
based on a belief that emotional problems stem from distorted attitudes and ways of thinking. Your
therapist helps you to revise negative or erroneous perceptions.
- Family counseling. This counseling can help address feelings of guilt and anxiety within a
family that may have led to a child's eating disorder.
- Medications. Antidepressant medications have proved to have some positive effect for people
with bulimia, but of little benefit to people with anorexia. Doctors frequently prescribe
antidepressants along with psychotherapy to treat bulimia. Most often, doctors prescribe selective
serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft),
paroxetine (Paxil) and fluvoxamine (Luvox, Floxyfral). Other antidepressant medications may include
venlafaxine (Effexor) and tricyclic antidepressants such as imipramine (Tofranil, Presamine) and
desipramine (Norpramin, Pertofrane). If you're experiencing depression and anxiety, which commonly
accompany eating disorders, antidepressant medications will benefit these conditions as well.
Making these steps a part of your routine can help you stay healthy if you've experienced anorexia or bulimia:
- Follow a regular schedule of meals.
- Stop eating when you're full, not stuffed.
- Eat healthy, well-balanced meals.
- Take vitamin and mineral supplements.
- Exercise regularly, but in moderation.
If you or your child has been prone to eating disorders, these steps may help you stay away from the self-destructive behaviors of anorexia and bulimia:
- See your doctor regularly. Discuss with your doctor any concerns you have about proper
weight and proper nutrition.
- Boost your self-esteem. Get involved in activities that interest you and that are
personally rewarding. These may include learning a new skill, developing a hobby or participating in a
social group in your church or community.
- Improve your family's dynamics. Work to improve the atmosphere of acceptance and inclusion
in your family. Often, low self-esteem can lead a child into anorexic or bulimic behaviors. Show your
child your love, and find ways to say good things about your child.
- Be realistic. Don't buy into what some of the media portray about what's a normal weight
and what's an ideal body image.
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July 1, 2002 —
