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 Medical Self-Care: Eating Disorders (Anorexia Nervosa & Bulimia) 
 
Anorexia nervosa and bulimia are two kinds of eating disorders. Anorexia nervosa is a form of self-starvation. Bulimia is eating large amounts of foods (binging) and then forcing oneself to throw up or using laxatives and water pills to get rid of what was overeaten (purging). These eating disorders are both a form of self-abuse.

Symptoms
Anorexia nervosa and bulimia seem like opposite conditions, but they share these common traits:

  • Fear of overeating and gaining weight
  • Depression
  • Low self-esteem, poor body image
  • Self-destructive outlook, self-punishment for some imaginary wrong
  • Disturbed family relationships
  • Increased rate of illness due to low weight, frequent weight gain/loss and/or poor nutrition
  • Abnormal preoccupation with food and feeling out of control
Anorexia Nervosa Sufferers:
  • Are mostly female, and/or preteen, teenage or college age
  • Tend to place too much emphasis on body image and perfection
  • May feel the need to be perfect to gain parental attention.
  • Have marked physical effects loss of head hair, slowed heart rate, low blood pressure, absence of menstrual periods
  • Tend to experience extreme depression more than bulimics
  • Develop osteoporosis in later life due to lack of calcium and decreased production of estrogen, if menstruation stops. Excessive exercise can contribute to this as well.
  • May have severe damage to heart and vital organs due to an excessive loss of weight and to a mineral imbalance from vomiting and/or poor nutrition
Approximately 1% of American females have anorexia.

Bulimia Sufferers:

  • Can be overweight, underweight, or normal weight
  • Are mostly female and older teen or young adult
  • Binge eat and then vomit (purge) and/or take laxatives or water pills (diuretics) to "undo" the binge
  • Have severe health problems that come from the binge-purge cycle of eating. These include stomach lining damage, irregular heartbeat, kidney damage from low potassium levels, and damage to tooth enamel from vomiting.
  • Repress anger because they can't express emotions in an assertive way. They fear upsetting important people in their lives.
Approximately 2% of college students and 1% of U.S. women overall have bulimia. Bulimia can follow anorexia and vice versa.

There is no one cause for these eating disorders. There are many factors. They include:

  • A possible genetic link
  • Metabolic and biochemical problems or abnormalities
  • Pressure from society to be thin
  • Personal or family pressures
  • Fear of entering puberty or becoming sexually active
Treatment
Treatment for anorexia and/or bulimia includes:
  • Medical diagnosis and care the earlier, the better
  • Psychotherapy individual, family, and/or group
  • Behavior therapy
  • Medication antidepressant medicine is sometimes used.
  • Medical nutrition therapy
  • Support group participation
  • Outpatient treatment programs
  • Hospitalization if your weight loss makes you 25% or more below normal weight and/or has affected vital functions
Treatment can vary in length as well as method. It can take from a few months to several years.

Questions to Ask

Have you lost a significant amount of weight by dieting and exercising on purpose (not due to any known illness) and do you have any of these problems?
  • An intense fear of gaining weight or of getting fat
  • You see yourself as fat even though you are at normal weight or are underweight.
  • You continue to diet and exercise excessively even though you have reached your weight goal.
Yes: See Doctor
No
Are you aware that your eating pattern is not normal and are you afraid that you will not be able to stop binge eating? Are you depressed after binging on food? Yes: See Doctor
No
Do you have a combination of these problems along with abnormal eating habits?
  • Irregular heartbeat
  • Slow pulse, low blood pressure
  • Rapid tooth decay
  • Low body temperature, cold hands and feet
  • Thin hair (or hair loss) on the head, babylike hair on the body (lanugo)
  • Dry skin, fingernails that split, peel, or crack
  • Problems with digestion, bloating, constipation
  • Three or more missed periods (in a row), delayed onset of menstruation, infertility Periods of depression and lethargy, euphoria and/or hyperactivity
  • Tiredness, weakness, muscle cramps, tremors
  • Lack of concentration
Yes: See Doctor
No
Do you do one or both of the following?
  • Hoard food
  • Leave the table right after meals to "go to the bathroom" to induce vomiting and/or spend long periods of time in the bathroom from taking laxatives and/or water pills
Yes: See Doctor
No
Do you have recurrent episodes when you eat a large amount of food at a very fast pace and do at least 3 of the following?
  • Eat high-calorie, easily eaten foods during a binge
  • Binge eat with no one watching Stop the binge eating when you get stomach pain, go to sleep, interact socially, or induce vomiting
  • Attempt to lose weight over and over with severe diets, self-induced vomiting, and/or laxatives or water pills
  • Have weight changes of more than 10 pounds due to binging and fasting
Yes: See Doctor
No
If you have answered NO to all of the above questions you are probably not suffering from anorexia nervosa and/or bulimia. If you are not sure, though, see a counselor for a professional assessment.

{Note: Eating disorders are too complex and physically harmful to be treated with self-care alone. Experts agree that experienced professionals should treat people who have eating disorders. See "Places to Get Information & Help" under "Eating Disorders" on page 375.}

Prevention
The following tips may help prevent an eating disorder:

  • Accept yourself and your body. You don't need to be or look like anyone else. Spend time with people who accept you as you are, not people who focus on "thinness."
  • Eat nutritious foods. Focus on complex carbohydrates (whole grains, beans, etc.), fresh fruits and vegetables, low-fat dairy foods, and low-fat meats.
  • Eat at regular times during the day. Don't skip meals. If you do, you are more likely to binge when you eat.
  • Avoid white flour, sugar, and "junk" foods high in calories, fat, and sugar such as cakes, cookies and pastries. Bulimics tend to binge on junk food. The more they eat, the more they want.
  • Get regular moderate exercise. If you find that you are exercising excessively, make an effort to get involved in nonexercise activities with friends and family.
  • Find success in things that you do. Your work, hobbies, and volunteer activities will promote self-esteem.
  • Learn as much as you can about eating disorders from books and organizations that deal with them.
  • Parents who want to help daughters avoid eating disorders should promote a balance between their daughters' competing needs for both independence and family involvement.
(Excerpted from Healthy Self: The Guide to Self-Care and Wise Consumerism)
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