Medical and Psychological Effects of Eating Disorders

[Tauri]

Medical and Psychological Effects of Eating Disorders
Tauri Hall, 2003

What is an Eating Disorder?
An eating disorder is an extreme expression of inner emotional or psychological distress or problems. Food or in some cases the denial of food, becomes the drug of choice. Eating or not eating helps to numb painful feelings. Without professional help and treatment, an eating disorder may persevere throughout life.

Anorexia Nervosa
Anorexia is characterized by extreme weight loss and restrictive dieting. Individuals suffering with anorexia will often report feeling fat despite actually being very thin. They are literally terrified of gaining weight. There are four central diagnostic criteria for anorexia nervosa.

1. Low Weight ? an individual body weight less than 85% of what is expected based on age and height. It is possible for a person who binges and purges to have anorexia if their body weight is excessively low.
2. Intense fear of gaining weight despite being extremely thin. An individual?s fear of weight increases as they progressively lose more weight.
3. Distorted image of shape or weight. People with anorexia nervosa believe that they are overweight and when they look into a mirror they see themselves as fat. They become preoccupied with loosing weight and their perception of their own body becomes extremely distorted.
4. Amenorrhea ? not having a menstrual period for at least three consecutive months (in females who have already started to menstruate). In men, there is no obvious way to notice a comparable change in hormonal cycles.

However, restrictive dieting and weight loss can lead to reduction in testosterone levels in males (Teachman; Schwartz; Gordic; Coyle 2003).

Bulimia Nervosa
Bulimia is characterized by a repeated cycle of binging eating, during which the individual consumes a large amount of food at once and feels out of control during the binge. The binge is followed by purging. Purging can take various forms such as vomiting, misuse of laxatives or diuretics, excessive exercise, or fasting. People suffering with bulimia nervosa find themselves trapped in the binge/purge cycle because the rigid dieting between binges leaves their body hungry. Similar to anorexia, people with bulimia often view themselves as overweight and are preoccupied with wanting to lose weight. They also believe that their self-worth is tied to being thin. There are five central diagnostic criteria for bulimia nervosa.

1. Reoccurring binge eating episodes. A binge is described as: eating an unusually large amount of food in a set period of time, feeling a lack of control over what is eaten and the quantity of food eaten. Some people who suffer with bulimia believe that they have binged when they eat a reasonable amount of food. This is called a ?subjective? binge. For these individuals eating is almost always anxiety provoking and therefore puts them at risk to purge (vomit, exercise, use laxatives) in order to compensate for eating and to alleviate their fear of gaining weight.
2. Reoccurring purging behaviours to prohibit weight gain. This includes vomiting, excessive exercise, abusing laxatives or diuretics, enemas, or other medications.
3. Binging and purging behaviour occur approximately twice a week for three consecutive months. This criterion is only a general guideline. What is important is not the frequency of the binge-purge cycle, but whether this pattern is physically or emotionally unhealthy and interfering with the individual?s well-being and functioning.
4. Overemphasis on shape or weight in evaluating him/herself. As with anorexia nervosa, individuals with bulimia nervosa place an excessive amount of importance what their body looks like and how much they weigh. They feel that their happiness is contingent upon being thin. They are preoccupied with their weight and shape which inhibits them from feeling fulfilled in other areas of their lives.

These difficulties are not occurring during an episode of anorexia nervosa. This final criterion is present to distinguish between people suffering with anorexia nervosa binge-eating/purging type from people suffering with bulimia nervosa. People with bulimia nervosa are generally within the normal weight range, despite efforts to purge following binge eating, because the purging and excessive exercise does not eliminate the majority of calories consumed during a binge.

Binge Eating Disorder (BED)
This disorder has recently been included as a research category in the Diagnostic and Statistical Manual of Mental Disorders, so it has been less researched than anorexia and bulimia nervosa. BED (sometimes referred to as compulsive overeating) is characterized by frequent binge eating episodes. Individuals with BED report feeling out of control and unable to stop eating. Binge eating is often done rapidly and secretly; feelings of shame and guilt may follow. Unlike people with bulimia, who follow binges with compensatory behaviours, people with BED do not usually vomit, over exercise, or abuse laxatives or diuretics (Teachman, Schwartz, Gordic, Coyle 2003). There are five central diagnostic criteria for binge eating disorder. You will notice overlap with bulimia; both disorders are characterized by binge eating.

1. Reoccurring binge eating episodes. A binge is described as: eating an unusually large amount of food in a set period of time, feeling a lack of control over what is eaten and the quantity of food eaten.
2. Episodes of binge eating include three or more of the following:
   
   • eating much faster than usual
     
   • eating while feeling full or uncomfortable
     
   • eating large quantities of food even when not hungry
     
   • eating alone and feeling ashamed by the amount eaten
     
   • feeling disgust, depression or guilt after overeating
3. Experiencing distress due to binge eating
4. Binge eating episodes occur approximately two days a week for six consecutive months.
5. There is no regular use of purging behaviours, and binge eating is not occurring during episodes of anorexia or bulimia nervosa.

How Common are Eating Disorders?
It is estimated that 3% of women will be affected by eating in their lifetime (DSM IV 1994). Eating disorders affect girls and women more than boys and men. Approximately 0.5% to 4% of women will develop anorexia nervosa during their lifetime and about 1 to 4% will develop bulimia nervosa (Steiger; Seguin 1999). Binge eating disorder (BED) affects about 2 - 4% of the population (Bruce & Agras 1992). Unlike anorexia and bulimia, BED affects both men and women equally.

Eating disorders are not bound by age, race, gender or background. Research suggests that a person?s genetic make up may play a role in the development of an eating disorder. Biological reasons, such as a parent or relative may also adversely influence the development of an eating disorder through the expressed attitudes towards food, eating and body shape and size. (National Eating Disorder Association website).

Traumatic events can trigger anorexia or bulimia nervosa: bereavement, being bullied or abused, upheaval in the family (such as divorce) or concerns about sexual orientation. Individuals with mental illness or a disability may also experience eating problems.

Medical Complications
The information about the medical consequences of eating disorders was adapted from the Web site of the National Eating Disorders Association. The following are lists of potential complications.

Health Consequences of Anorexia Nervosa
The primary medical problems associated with anorexia nervosa result from self-starvation, causing the body to slow down all of its natural processes in an attempt to conserve energy. By denying the body of nutrients it needs, an individual becomes vulnerable to a number of serious health issues:

• Abnormally slow heart rate and low blood pressure leading to increased risk for heart failure
• Reduction of bone density (osteoporosis), resulting in dry, brittle bones
• Muscle loss and weakness
• Severe dehydration, may result in kidney failure
• Dry hair and skin, and hair loss
• Growth of a downy layer of hair called ?lanugo? all over the body, including the face, as an effort to keep the body warm.

Health Consequences of Bulimia Nervosa
Medical complications resulting form bulimia nervosa are mostly a result of recurrent binge-and-purge cycles. The compensatory/purging behaviours associated with bulimia can affect the entire digestive system and lead to electrolyte and chemical imbalances in the body. Potential health consequences of bulimia nervosa include, but are not limited to:

• Electrolyte imbalances, leading to irregular heart beats and possible heart failure and death
• Potential for gastric rupture during periods of binge eating
• Inflammation and possible rupture of the esophagus from frequent vomiting
• Tooth decay and staining from stomach acids released during frequent vomiting
• Chronic irregular bowel movements and constipation as a result of laxative abuse
• Peptic ulcers and pancreatitis

Health Consequences of Binge Eating Disorder
The majority of medical risks associated with binge eating disorder are due to health impacts of clinical obesity, including:

• High blood pressure
• High cholesterol levels
• Heart disease as a result of elevated triglyceride levels
• Secondary diabetes
• Gallbladder disease
• Psychological Problems

Eating disorders are a mental health problem, as well as, a threat to physical health and well-being. The information about the psychological consequences of eating disorders was adapted from the Web site of the National Eating Disorders Association. The following are lists of potential complications. Keep in mind as you read the list below, that it is not clear which problem comes first, the eating disorder or the psychological problem associated with it.

• Depression (sometimes severe enough to lead to suicide)
• Feeling of being out of control and helpless to do anything about personal issues
• Anxiety, self-doubt
• Guilt and shame
• Suspicion of others wanting to interfere, may include slight paranoia
• Fear of discovery
• Obsessive thoughts and preoccupations
• Compulsive behaviours; rituals dictating most activities, especially around food
• Feelings of alienation and loneliness
• Feelings of hopelessness

If you think that you or someone you know is suffering with an eating disorder it is important to seek professional help. Recovery is possible!

Bibliography
Hall, Lindsey, & Ostroff, Monika. Anorexia Nervosa: A Guide to Recovery. Gurze Books, 1998

Hall, Lindsey, & Ostroff, Monika. Bulimia: A Guide to Recovery. Publishers Group West, 1999

Meadow, Rosalyn, & Weiss, Lillie. Women's Conflicts about Eating and Sexuality: The Relationship Between Food and Sex. Haworth Press, 1993

Normandi, Carol, & Roark, Lauralee. Over It: A Teen's Guide to Getting Beyond Obsessions with Food and Weight. New World Library, 2001

Pipher, Mary. Reviving Ophelia: Saving the Selves of Adolescent Girls. Ballantine Books, 1995

Roth, Geneen. When Food is Love: Exploring the Relationship Between Eating and Intimacy. Plume, 1992

Teachman, Bethany, Schwartz, Marlene, Gordic, Bonnie, & Coyle, Brenda
Helping Your Child Overcome an Eating Disorder: What You Can Do at Home. New Harbinger, 2003