How Eating Disorders Can Harm You!!!

Sharon Chan

Everybody is susceptible to eating disorders; however, women are generally more affected than men. Without treatment, there will be grave consequences, which can even result in death. So what exactly are eating disorders? In certain aspects, eating disorders can be defined to be a disease of self-esteem. It is a manifestation of more than just a troubled relationship with food or an obsession with thinness. The existence of food and weight issues merely pose as indicators of the presence of a problem. In order to regain a sense of control, individuals turn to unhealthy patterns of eating such as dieting, bingeing and purging to cope with their emotional problems [1]. Three main eating disorders are anorexia nervosa, bulimia nervosa and the binge eating disorder.

A main feature of anorexia nervosa is the unyielding pursuit of thinness, usually expressed by starvation and excessive exercise, whereas vomiting and the use of laxatives and diuretics is a less frequent occurrence. In addition, amenorrhea, which is a loss of menstrual periods, is also a distinct feature of this disorder on top of several other diagnostic criteria, which individuals have to fulfill before being diagnosed as anorexic. To name a few, individuals reject the idea of maintaining a minimal normal weight for their respective height and build, resulting in a body weight that is fifteen percent lower than expected. In spite of this, an immense fear of becoming fat is still present, while they concurrently view their body size or weight from a disturbed point of view. In the case of females, under normal circumstances, there must be an absence of three consecutive menstrual cycles [2].

General outcomes of anorexia nervosa are a very thin appearance, the development of brittle hair and nails, dry skin, low pulse rate, inability to withstand cold conditions, and constipation or diarrhea. To a more serious extent, the individual’s blood count is affected, bringing about mild anemia as well as low blood pressure, reduction of muscle mass, oedema and the swelling of joints [3]. On a long-term basis, consequences include amenorrhea due to the reduction of body fat, lack of calcium due to poor diet leads to osteoporosis, otherwise also known as bone thinning, and as an adaptation to keep the body warm, the growth of fine, light coloured body hair. Ultimately, anorexia nervosa can lead to death as a result of complications like heart and kidney failure, stroke and other consequences of malnutrition[1].

Among the complications of anorexia nervosa, cardiac, fluid and electrolytes disorders are the most lethal. For example, a decrease in cardiac muscle mass, chamber size and output, in addition to low serum potassium levels and the occurrence of dehydration and metabolic alkalosis. The mentioned examples are all aggravated by induced vomiting and the use of laxatives and diuretics. Finally, sudden death can be brought about by ventricular tachyarrhythmias. Treatment of anorexia nervosa primarily focuses on weight restoration, and this involves two phases: short-term intervention and long-term therapy. Firstly, anorexic individuals undergo short-term intervention to reinstate body weight. Once the patient’s nutritional, fluid and electrolyte status has been re-established, long-term therapy to improve psychological functioning starts. This therapy, together with fluoxetine, prevents a relapse from taking place [4].

Likewise, a main feature of bulimia nervosa is the occurrence of recurrent episodes of binge eating followed by self-induced vomiting or laxative abuse to rid the body of unwanted food. The duration and frequency of binge eating varies from minutes to hours and up to many times a day. Initially, binge eating is approached with a pleasurable and soothing sentiment; however, this sentiment is rapidly replaced by guilt and depression, leading to the fear of a loss of control. One main specification for bulimic patients is normal weight, and this excludes anorexic or obese subjects from the bulimic category. In this case, self-induced vomiting and the use of laxative and diuretics are more frequent than anorexic cases. Prolonged fasting or excessive exercise is employed in order to maintain a relatively normal weight. Even though bulimic patients also harbour the fear of being fat, especially after a binge, they do not seem to strive toward an unrealistically low weight. The other main diagnostic criteria for bulimia includes the consumption of high-caloric food and inconspicuous eating during a binge; where abdominal pains, sleep, social interruption or self-induced vomiting concludes bingeing episodes. Repeated efforts to lose weight by strictly controlled diets, self-induced vomiting or the use of cathartics or diuretics lead to recurrent weight fluctuations of more than ten pounds due to alternating binges and fasts. On top of that, individuals are aware of their abnormal eating pattern, thus inducing a fear of bingeing [2].

General health effects of bulimia nervosa mainly revolve around electrolyte imbalance, the increase or decrease in levels of sodium and potassium in the body, and repeated purging behaviours. In the process of vomiting, the body loses potassium, resulting in heart muscle damage, hence increasing an individual’s risk of suffering from a heart attack. At the same time, frequent vomiting inflames the oesophagus and damages the tooth enamel. Additional outcomes are scarring on the back of the fingers due to pushing them down the throat to induce vomiting, the change or loss of menstrual periods and no sex drive. Emotionally, bulimic patients find it difficult to handle impulses, stress and anxiety. On top of that, they also suffer from depression, obsessive-compulsive disorder, which is an illness where undesirable thoughts and behaviours cannot be controlled, as well as other mental illnesses [3].

Long-term, bulimic patients suffer from chronic sore throat related to vomiting, severe tooth and gum decay, like the erosion of dental enamel of the front teeth, as well as painless salivary gland enlargement. Bruising around the eye or mouth, dehydration and rectal bleeding also occur [1]. In grave consequences, severe fluid and electrolyte imbalance, particularly hypokalemia, takes place intermittently. On rare occasions, the oesophagus is torn or the stomach is ruptured during binge eating, resulting in life-threatening complications. Moreover, long-term usage of syrup of ipecac to induce purging can lead to cardiomyopathy.

Treatment for bulimia nervosa includes the use of antidepressants, even if depression is not present, and psychotherapy, either cognitive-behavioural or interpersonal therapy. Comparatively though, psychotherapy produces better long-term results, but some evidence suggests that the combination of antidepressants and psychotherapy proves to be the most effective method [4].

Binge eating disorder is a newly delineated disorder that is characterized by uncontrollable eating. Individuals with binge eating disorder binge but do not self-induce vomiting; thus they are often found to be overweight. Individuals in this category fear gaining weight too. In addition, they dislike the way their body’s look and try to lose weight. However, unsuccessful diet attempts bring about stress, which ultimately leads back to further bingeing. People suffering from this disorder seem caught up in a vicious cycle. They feel disgusted and ashamed when they binge, yet all these emotions only bring them back to square one, as bingeing is the only way they know to release these emotions.

Binge eating disorder differs from both anorexia nervosa and bulimia nervosa in the sense that the predominant gender in this category is male rather than female. The diagnosis of binge eating disorder is not an easy task as overweight individuals are often assumed to have a large appetite and a lack of self-control [1]. Generally, long-term health problems resemble those found with obesity, such as high levels of cholesterol, high blood pressure and secondary diabetes. More serious circumstances involve increasing the individual’s risk in acquiring gall bladder disease, heart disease as well as some types of cancer. Emotionally, people with binge eating disorder frequently experience depression [3]. No standard treatment program for binge eating disorder exists. Most patients undergo the usual weight-loss program for obesity, which does not focus on bingeing. As most of the patients are more preoccupied with obesity rather than bingeing, they seem to be accepting the current situation fairly well [4].

In conclusion, it is possible for eating disorders to be treated and for the patients to resume a normal, healthy life. Like all other illnesses, the chances of recovery are the highest when the eating disorders are discovered in the early stages. Moreover, the body deteriorates when eating disorders are prolonged, hence possibly leading to serious health problems. It should also be noted that there is no foolproof way to treat these complex disorders. The main treatments available include medical care, psychotherapy and nutritional counseling. Psychotherapy includes family and group therapy as well as cognitive-behavioural therapy, which changes an individual’s mindset and their reactions toward anxious or fearful situations. As mentioned earlier in the treatment of bulimia nervosa, antidepressants can be used to prevent relapses. A specific example of an antidepressant is serotonin reuptake inhibitor. It has been shown to maintain weight and control anxiety for anorexic or bulimic patients. Last, but not least, the building of an individual’s self-esteem plays a major role in their recovery [3]. Their depression or fear no longer dominates their relationship with food.

References:

1. American Anorexia & Bulimia Association (1997). Eating Disorders. http://www.bu.edu/wellness/healthupdates/eatdis.html [internet resource].
2. Blinder, B.J., Chaitin, B.F. & Goldstein, R.S. (1998). The Eating Disorders. New York: PMA Publishing Corporation.
3. Hendrick, V. (2002). Eating Disorders. http://www.4woman.gov/faq/eatingdi.htm [internet resource].
4. Beers, M.H. & Berkow, R. (2003). The Merck Manual of Diagnosis and Therapy. http://www.merck.com/pubs/mmanual/section15/chapter196/196c.htm [internet resource].