They are high-profile problems, often in the news, linked to celebrities. Yet most of us have little real understanding of anorexia and bulimia, which remain notoriously difficult to treat. Perhaps this is because eating disorders are on one level about food – refusing food, bingeing on food, “purging” food – yet they can also involve complex emotional and psychological problems.
In anorexia nervosa, people (mostly young women) starve themselves, sometimes to the point of death. Anorexics often become skeleton-thin, yet they don’t see themselves that way. Emotionally they may become irritable, isolated, depressed – even suicidal. Excessive exercising is sometimes a part of the picture, coupled with loss of sleep.
With extreme weight loss also come the unpleasant symptoms of malnutrition and dehydration. As body fat is lost and muscle protein broken down to provide energy; women’s periods will stop, teeth will decay or be lost, the blood will lose important minerals, there will be increased risk of osteoporosis in later life – and there may also be inflammation and even rupture of the stomach and oesophagus.
In bulimia nervosa (which is more common than anorexia and often follows it), binge eating is followed by self-induced vomiting, periods of starvation and/or purging with laxatives. People with bulimia – mostly women, and generally of an older age group than anorexics – also go through emotional extremes, often feeling out of control, helpless and lonely.
Because self-induced vomiting is a source of shame, people with bulimia are often devious and deceptive about their problem, going to the bathroom after meals to “get rid” secretly of what they’ve eaten. Habitual vomiting can also erode tooth enamel and cause sore throats, while menstrual disorders may follow and again the risk of osteoporosis is increased.
So what leads (mostly) women to such desperate measures? Some authorities believe that anorexia and bulimia may be ways of avoiding other, more painful emotional problems, or of coping with long-buried stresses. Their figures show that a third of anorexics and bulimics who seek therapy have been sexually abused.
Alternatively, it may be a way of exerting control, especially tempting to a women who may feel that their bodies are about the only thing in life they can control. People with eating disorders commonly see “control” over eating as the answer to other problems – until anorexia or bulimia begins to make them so ill that the condition becomes the number one concern.
These problems are not helped by the fashion industry’s promotion of unnaturally thin models. The pressure an already stressed person feels to strive for this public image of beauty may be the trigger that starts the illness.
Another theory is that some eating disorders have a straightforward physiological origin, beginning with food allergy which results in food “addiction”.
Only in the last 20 years have anorexia and bulimia been recognized by the medical profession as “diseases”. People with anorexia and bulimia can and do get better – especially when the disorder is recognized early and treated.