Anorexia Nervosa
Anorexia nervosa, which afflicts adolescent and young women,
is the relentless pursuit of thinness through self-starvation. Basically,
anorexia nervosa is a psychiatric disorder with the main issue a struggle for control
and a sense of identity. Many young women affected with this disorder have
struggled for years to make themselves over and to be “perfect” in the eyes of
others, usually of parents with extremely high expectations. Their concept of
their own body image becomes distorted, and even when they are less than ideal
body weight for their age, height, and body frame, they see themselves as fat
when looking in a mirror.
The outstanding characteristic of this disorder is reduced
calorie intake. Not only is the amount of food rigidly restricted, but the
whole pattern of eating becomes disorganized in bizarre ways. In many cases,
the absence or denial of hunger alternates with an uncontrollable impulse to
gorge. After gorging, the anorectic may induce vomiting or take laxatives to
purge herself (see section on bulimia). Paradoxically, anorexia nervosa is
often preceded by obesity and usually begins or becomes overt with dieting. The
ordinary dieter makes the supreme sacrifice each time she rejects an ice cream sundae
or suffers every time she declines her hostess’ offer of chocolate cake. In
contrast, the anorectic adolescent will insist that she is not hungry, does not
need to eat, and that not wanting to eat is “normal.” In contrast to her
emaciated appearance, she is overly active, often exercising religiously for
many hours each day or increasing her participation in sports. She is an
overachiever and her parents will describe her as “a real perfectionist.”
Secondary amenorhea, the cessation of menstrual periods, though a
characteristic feature of anorexia nervosa, is not an essential part of the
disorder. Because the menstrual cycle is so easily affected by emotional
disturbances, loss of periods is commonly observed in women under severe
stress, and the psychological as well as nutritional stresses on the anorectic
are indeed severe. In advanced stages of emaciation, which these young women
often reach, true loss of appetite may result from severe nutritional
deficiency, similar to the complete lack of interest in food that occurs in the
late stages of starvation during a famine. If such becomes the case,
hospitalization may be recommended. Before such an advanced stage of the
illness is reached, it is essential that the condition be approached by
psychotherapists who specialize in the treatment of eating disorders. Therapy
usually involves the family as well as the young woman herself.
Who Suffers
From Anorexia Nervosa?
Anorexia nervosa and its associated syndrome, bulimia or
bulimarexia, are extremely widespread and dangerous problems. The chief
symptoms are self-induced starvation and/or binge eating and purging. For many,
this is a compulsive addiction, like alcoholism.
Thousands of cases report ill health, psychological
impairments, shame, guilt, withdrawal and isolation -- all leading to
devastated lives. The illness is also highly destructive to other family
members and friends.
The National Association of Anorexia Nervosa and Associated
Disorders -
¨
Several facts
point to the impact of eating disorders to individuals and families: There are
at least 8,000,000 or more victims in this country alone. It is estimated that
six percent of serious cases die.
¨
Ninety percent
are women. Male cases are being reported with increasing frequency.
¨
Eating
disorders can lead to death or life-long problems in the self-starver and even
in those of normal weight who compulsively binge and purge, but it can be
cured.
¨
Reports to
ANAD show that victims may be rich or poor.
¨
Although most
anorexics and bulimics start in their teens, a significant number are now in
their upper twenties, thirties, forties or older.
¨
More cases are
being reported in the eight- to eleven-year-old bracket.
Many physicians and other health professionals have not been
trained to recognize or treat anorexia. Parents and families may not have basic
information concerning eating disorders, including recognition of symptoms,
psychological insights or nutritional requirements.
Thus, the opportunity of early detection and treatment is
often lost. The illness is not diagnosed until it reaches an advanced stage,
when it is more difficult to treat. Recognizing and coping with anorexia is
still in the pioneer stage, with an enormous need for public education and the
training of health professionals.
Many medical doctors and others in the health field endorse
and support ANAD policies and services. All programs involve close association
with health professionals.
Writers and producers can reach a broad, interested public
by disseminating information on these compelling problems and can perform a
valuable public service by listing ANAD as a source for free information or
assistance.
Facts About Eating Disorders
A.
EATING DISORDERS ARE WIDESPREAD AND DESTRUCTIVE
1.
Eating
disorders cause immeasurable suffering for victims and families.
2.
Eating
disorders have reached epidemic levels in
3.
Seven million
women
4.
One million
men
5.
Victims lose
the ability to function effectively -- great personal loss and loss to society
1.
86% report
onset of illness by the age of 20*
2.
10% report
onset at 10 years or younger
3.
33% report
onset between ages of 11-15
4.
43% report
onset between ages of 16-20
1.
77% report
duration from one to fifteen years*
2.
30% report
duration from one to five years
3.
31% report
duration from six to ten years
4.
16% report
duration from eleven to fifteen years
5.
It is
estimated that six percent of serious cases die
6.
Only 50%
report being cured
D.
COST OF TREATMENT
Treatment for anorexia nervosa and/or bulimia is often
extremely expensive. Large numbers of victims require extensive medical
monitoring and treatment, and therapy generally extends over two years or more.
Cost of inpatient treatment can be $30,000 or more a month.
Many patients need repeated hospitalizations.
The cost of outpatient treatment, including therapy and
medical monitoring, can extend to $100,000 or more.
Eating disorders are rampant in our society, yet few states in the nation have adequate programs or services to combat anorexia nervosa and bulimia. Only a small number of schools and colleges have programs to educate our youth about the dangers of eating disorders.
Every state in our nation and thousands of schools have
extensive programs aimed to prevent alcoholism and drug abuse. The value of
such programs, especially education programs, has been proven and accepted into
school curricula.
The immense suffering surrounding eating disorders, the high
cost of treatment and the longevity of these illnesses make it imperative that vastly
expanded education programs be implemented to prevent anorexia nervosa and
related disorders.
Since 86 percent of victims report the onset of their
illness by age 20, education programs should focus on these ages in order to
maximize preventive efforts.
ANAD education/early detection/prevention programs provide
models for low cost outreach services that benefit hundreds of thousands of our
youth. ANAD has urged federal and state governments to undertake and develop
education programs for our citizens.
Warning Signs for Eating Disorders
A.
ANOREXIA NERVOSABULIMIA NERVOSA
1.
Deliberate
self-starvation with weight loss.
2.
Preoccupation
with food.
3.
Intense,
persistent fear of gaining weight.
4.
Binge eating,
usually in secret.
5.
Refusal to
eat, except in tiny portions.
6.
Vomiting after
bingeing.
7.
Continuous
dieting.
8.
Abuse of
laxatives, diuretics, diet pills.
9.
Excessive
facial/body hair due to inadequate protein in the diet.
10. Denial of hunger or drugs to induce vomiting.
11. Compulsive exercise.
12. Abnormal weight loss.
13. Swollen salivary glands
14. Sensitive to cold.
15. Broken blood vessels
in the eyes.
16. Absent or irregular menstruation.
17. Hair loss.
B.
PHYSICAL REPERCUSSIONS FROM ONE OR BOTH DISEASES
1.
Malnutrition
2.
Intestinal
ulcers
3.
Dehydration
4.
Ruptured
stomach
5.
Serious heart,
kidney, and liver damage
6.
Tooth/gum
erosion
7.
Tears of the
esophagus
C.
PSYCHOLOGICAL REPERCUSSIONS FROM BOTH DISEASES
1.
Depression
2.
Low
self-esteem
3.
Shame and
guilt
4.
Impaired
family and social relationships
5.
Mood swings
6.
Perfectionism
7.
"All or
nothing" thinking
Confronting a Person with Anorexia or Bulimia
When confronting a person with an eating disorder, it is
important to have a plan. A confrontation can be difficult due to denial seen
in those with the problem. However, even if a person does deny the problem, the
initial seed has been planted. At some point in the future, the problem will be
recognized and admitted. The following scheme is helpful to use when doing a
confrontation:
The Plan: "CONFRONT"
Concern
The
reason you are doing the confronting. You care about the mental, physical and
nutritional needs of the person.
Organize
Decide
WHO is involved, WHERE to confront, WHY concern, HOW to talk, WHEN is a convenient
time.
Needs
What
will be needed after the confrontation? Professional help and/or support groups
need to be available.
Face
The
actual confrontation. Be empathetic, but direct. Do not back down if the
problem is initially denied.
Respond
By
listening carefully.
Offer
Help and suggestions.
You
may want to encourage the person to contact you when there is the need to talk
to someone.
Negotiate Another time to talk and a time span to seek professional
help.
Time
Remember
to stress that recovery takes time and patience. However, there is a lot to
gain by the process and a lot to lose if the choice is made to continue the
existing behaviors.
Some Therapies Used In Anorexia Nervosa & Bulimia
Because information on many therapies used in anorexia
nervosa is not well distributed, here is a brief description of several types
of therapy. Since there is also considerable difference between therapists
regarding length of treatment, this information is given when such a
stipulation has been made. You may want to discuss questions with your
therapist.
Length of treatment varies from ten sessions, according to
Mara Palazzoli, to two or three years, according to Hilde Bruch. In the ten sessions,
Italian researcher Palazzoli uses family therapy with a team approach and
claims a one hundred percent cure rate for females between the ages of 13 and
16. American researcher Hilde Bruch states that improvement is achieved with
two to three years of psychotherapy, in which attention is directed to the
problems of low self-esteem, guilt, anxiety, depression and a sense of
helplessness.
Family therapy, as advocated by Salvador Minuchin, focuses
on changing the patterns of family interaction and is used at the
Conjoint family therapy, as taught by Virginia Satir, should
be useful in changing family patterns of interaction. More reports are needed
on its effectiveness with anorexia nervosa.
Trance therapy, practiced by John Hevesi, in
Hypnosis is employed by some therapists but may be resisted
by many anorexics who fear even a semblance of control by others. Some success
is claimed by those teaching self-hypnosis and biofeedback techniques during
three to six months of hospitalization.
There are several therapists who use brief therapy. A
variety of techniques are employed. One therapist successfully used techniques
from Palazzoli's "Paradox and Counter-Paradox" to stop symptoms of
gorging and vomiting, along with other methods assisting the achievement of
independence. Treatment time was about three months.
One psychologist used task-oriented techniques to enable a
46-year-old woman to stop a long-standing problem of gorging and vomiting in
about three months.
It is apparent, though, that therapy sometimes appears to be
effective in a relatively short time, even though the individual may have seen
many therapists previously. This may in part be due to readiness for change in
the individual, an effective therapist or an especially empathic
therapist/patient relationship. When recovery is achieved through short-term
therapy, one must be aware that return to a completely whole personality may
require further exploration and support. To find therapists using these and
other techniques, call psychologists, social workers, or psychiatrists listed
in your phone book or other sources. Ask specifically about their treatment
philosophy, the number of anorexics or bulimics they have treated, how
successful the treatment was and what was the average length of treatment. If
the response seems promising, a few sessions should give you some feeling of
the therapist's effectiveness for you, and you can decide whether to remain or
find someone else. Any effective therapy will ultimately prove itself by the
progress you make toward your goal.
ANAD
Hotline:
Fax: 847-433-4632
E-mail: info@anad.org
Web: http://www.anad.org/