Eating Disorders

Individuals with eating disorders are extremely concerned with their weight and body shape. Although the reason for this high level of concern is complex and varies between individuals, in all cases it results in an antagonistic relationship with food and eating. From there, maladaptive attempts to control body weight, unhealthy eating behaviors and distorted beliefs about food develop.

Eating disorders are most prevalent in females (with about a 10:1 female-to-male ratio in prevalence) and most often develop during adolescence or early adulthood (although some people acquire eating disorders later in life). Full-blown eating disorders occur in about 5% of the young female population, but the percentage of girls and women with "sub-clinical" eating disorders (those showing symptoms but not meeting the full diagnostic criteria) is closer to 25%.

Anorexia nervosa is a condition that causes people to restrict the amount of food they eat to the extent that their weight drops 15% or more below the weight expected for their height. A strong drive for extreme thinness and a morbid fear of gaining weight are central characteristics of this disorder. Extreme weight loss may lead to significant physical problems including anemia, hormonal changes (females with anorexia nervosa stop having, or never get, their menstrual period), cardiovascular problems, and dental problems -- some of which may lead to life-threatening conditions. An anorexic may limit caloric intake mainly through food restriction, or may combine this with excessive exercise, vomiting and other forms of purging (a significant percentage of anorexics also show signs of bulimia nervosa).

In contrast to sufferers of anorexia nervosa, those with bulimia nervosa tend to maintain a fluctuating weight within the normal range. Bulimia is characterized by recurrent binge-eating followed by extreme guilt and the compulsion to either vomit or use laxatives to compensate for the massive caloric intake (at times, thousands upon thousands of calories) ingested during the binge. For bulimia to be considered a clinical condition, such binge-and-purge behaviour must be present at least twice a week for at least three months. However, even in cases where binging and purging occur less than twice a week, the pattern may be associated with significant levels of body dissatisfaction, depression and anxiety, and as such, should be considered an important health problem and a reason for concern.

The cause of eating disorders is not definitive and it would appear that eating disorders result from a variety of different causal factors. These include childhood feeding difficulties, previous issues with being overweight, the modeling of faulty weight control methods, stress in adolescence (specifically with anorexia, this may involve a fear of physical maturation and associated psychosexual issues), sexual abuse, low self-esteem, and problematic family dynamics which impede a natural sense of personal identity.

Treatment for eating disorders involves psychological and nutritional counseling. Medical supervision is required. Family therapy is often helpful. Hospital-based programs where patients are required to comply with prescribed eating and activity plans may be necessary in some cases where the individual is unwilling or unable to initiate the behavior change on her own. However, as is the case with addictions, one can not be coerced into changing an eating disorder. Ultimately, the individual must "choose" to modify her eating and exercise patterns, which requires a new perspective on the eating disorder, allowing a change in self-perception and body-perception.