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 Medical Self-Care: Women's Health: Eating Disorders (Anorexia & Bulimia) 
 
An eating disorder may be defined, in a sense, as self-abuse. It can be just as harmful to your health as substance abuse involving alcohol or drugs. Two of these disorders, anorexia and bulimia, result from the fear of overeating and gaining weight.

They share other common traits, as well, that reflect the mental/physical health of the sufferer:

  • Depression.
  • Low self-esteem, poor body image.
  • Self-destructive outlook, self-punishment for some imaginary wrong.
  • Disturbed family relationships.
  • Abnormal pre-occupation with food and feeling out of control.
  • Increased rate of illness due to low weight, frequent weight gain/loss and/or poor nutrition.

In addition, anorexia and bulimia have factors specific to each:

  • Anorexia Nervosa sufferers tend to:
    • Be female, pre-teen or teenage.
    • Grow up in over-achieving families who establish unusually high expectations for their children.
    • Place exaggerated emphasis on body image and perfection.
    • Have parents who are very busy and involved in their own lives. The anorexic may feel the need to be perfect to gain their parents’ attention.
    • Have marked physical effects - loss of head hair, stoppage of ovulation/menstruation, slowed heart rate, low blood pressure, cold intolerance.
    • Have depression more extreme than in bulimia patients.
    • Develop osteoporosis later in life due to lack of calcium and decreased production of estrogen if menstruation stops. Excessive exercise can contribute to this as well.
    • Have severe damage to heart and vital organs if weight drops sufficiently.
    • Approximately 1% of American females have anorexia.
  • Bulimia sufferers:
    • Can be overweight, underweight or normal weight.
    • Are mostly female, older teen or young adult.
    • Are characterized by binge eating and then vomiting (purging) and/or taking laxatives and/or water pills (diuretics) to undo the binge.
    • Have severe health problems that arise from binge-purge cycle of eating. These include stomach lining tears, ruptures, irregular heartbeat, kidney damage from low potassium levels, damage to tooth enamel from acids produced in vomiting and menstrual stoppage.
    • Repress anger from inability to 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. Many factors contribute to them:

  • A possible genetic predisposition.
  • Metabolic and biochemical problems or abnormalities.
  • Societal pressure to be thin.
  • Personal or family pressures.

Treatment for anorexia and/or bulimia includes:

  • Medical diagnosis and care, the earlier the better.
  • Psychotherapy, individual, family or and/or group.
  • Behavior therapy.
  • Medication. Antidepressant medicine is sometimes used.
  • Nutrition therapy, including vitamin and mineral supplements.
  • Hospitalization, if necessary, especially in anorexia, if weight has dropped about 25% or more below normal weight and/or has affected vital functions.

Questions to ask

Have you gotten to a weight that is over 15% less than what is standard for your age and height by intentionally dieting and exercising (not due to any known illness)?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 any of these problems?

  • Irregular heartbeat.
  • Slow pulse, low blood pressure.
  • Low body temperature, cold hands and feet.
  • Thin hair (or hair loss) on the head, baby-like 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.
  • Sometimes depression and lethargy, sometimes euphoria and hyperactivity.
  • Tiredness, weakness, mus-cle cramps, tremors.
  • Lack of concentration.
Yes:See Doctor
No
Do you have an intense fear of gaining weight or of getting fat or see yourself as fat even though you are of normal weight or are underweight? Do you continue to diet and exercise excessively even though you have reached your goal weight?Yes:See Doctor
No
Do you:
  • 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 as a result of taking laxatives and/or water pills?
Yes:See Doctor
No

Do you have recurrent episodes when you eat a large amount of food in less than two hours time, at a very fast pace, and do you do at least three of these?

  • Eat a high calorie, easily eaten food during a binge.
  • Binge eat with no one watching.
  • Stop the binge eating when you get abdominal pain, go to sleep, interact socially or induce vomiting.
  • Attempt to lose weight repeatedly 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
Self-Care

Self-Care Procedures

Eating disorders are too complicated and physically hazardous to be treated with self-care procedures. Experts agree that experienced professionals should treat people who have eating disorders. But, to avoid succumbing to an eating disorder, follow these suggestions:

  • 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 a wholesome nutritious diet. 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 so, you are more likely to binge when you do eat.
  • Avoid refined foods such as white flour and sugar and “junk” food high in calories such as cakes, cookies or pastry, which have fat and sugar. 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 non-exercise activities with friends and family.
  • Find success in things that you do. Your work, hobbies and volunteer activities will promote self-esteem.
  • Educate yourself. 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.

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