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Anorexia and bulimiaBoth diseases are much more than 'slimming diseases'. Sufferers may have been abused as children or have been in painful relationships, and use the destructive eating pattern to gain control over their lives.

What are the symptoms?

The stereotypical image of an anorexic is of a bed-bound teenage girl looking as though she's just arrived from one of the world's famine spots. But it's important to remember that this kind of intense starvation is not the only symptom of an eating disorder. A person with an eating disorder may maintain a normal body weight and so their condition may go unnoticed for years. This is more often the case with bulimia.BulimiaLike anorexia, bulimia develops from an obsessive desire to be thin. However, instead of not eating, the person alternates between frantic bingeing and drastic purging (by self-induced vomiting and the abuse of laxatives and diuretics) or periods of excessive fasting and exercise.The feelings about body weight and shape may not result in an attempt to loose dramatic amounts of weight, and so the condition can continue. In the long-term this can cause:

  • irregular heartbeat
  • damaged kidneys
  • eroded teeth.

Compulsive eatingCompulsive eaters differ from people with bulimia in that, after binge eating, they don't try to get rid of what they've eaten. Many of them feel powerless to control their desire to keep 'comfort eating'. They may develop health problems as a result of carrying too much weight. AnorexiaThis often starts during the teens and may be a result of emotional problems connected with becoming an adult, as well as low self-esteem and/or physical or emotional abuse.It shares many features with bulimia. People with anorexia develop a fear of fatness that goes far beyond that of most dieters. The need to control their weight dominates all other emotions and food becomes the central issue of their lives.Binge eating is less likely, but the obsessions with weight and shape, exercising and the use of vomiting and laxatives to reduce weight are often major elements. Other signs before a person loses a dramatic amount of body weight include:

  • failure to notice or be satisfied with the result of exercise
  • avoiding food high in carbohydrates
  • low mood
  • irregular or stopped menstrual cycle
  • lack of interest in sex.

People with anorexia have a very low body weight, which can cause serious medical problems, including poor circulation, brittle bones, infertility, fainting and dizziness, dehydration and kidney damage. The consequences of inadequate nutrition in the long term can be slowed heartbeat, low blood pressure and reduced body temperature.It's important to seek medical help as soon as possible because some of these problems, if left untreated, may not improve when the person recovers from anorexia.How common is it?Although anorexia is the illness that receives the most media attention, bulimia is in fact far more common. Both occur mainly - though not exclusively - in women. Sufferers are usually, but not always, middle class and white.Bulimia is estimated to affect between one and two per cent of women aged 15 to 40. Anorexia is estimated to affect from one to five teenage women in every 100,000, and the age at which most cases develop is 16 to 17. For the few boys who develop the problem (about five to ten per cent of all cases), 12 is the peak age. What can I do to help myself?Although it sounds predictable, if you're at the stage where you're asking: "What can I do to help myself?", then you're halfway to recovery. It's important to be clear about your ideal body weight and shape. It may be that you're having difficulty judging this.Opening up to someone is a huge step forward, so it's important to find someone who you can trust to talk this over with - this may be a friend or a therapist or counsellor. For more details, see the list at the end of this page.Having negotiated acceptable limits to your weight and shape, you then need to negotiate an acceptable eating and exercise plan. This sounds very easy, but sticking to it can prove difficult. Maintaining a regular diary of eating, thoughts and feelings can be helpful.People suffering with anorexia often feel that by gaining weight they're losing control over their body, and start to suffer from anxiety and depression. It's as important to address these underlying issues as it is to try to alter eating behaviour.If you decide to seek professional help, your GP can help you adjust to a healthier way of eating and refer you to more specialist services that will help deal with problems such as low self-esteem. If you've been fasting, you'll need to start by eating small portions of easily digested food until your system learns to cope. Admission to a hospital or specialist clinic will help your recovery if you're very weak.Other options include talking treatments and self-help groups where you can talk to others with the same problem. Dance and movement therapies can also help a person to feel more connected to and happier with their body. Whatever form of help you choose, the support of friends and family is very important.

How can I help my teen?

Teenage girls are at the greatest risk of developing anorexia, and parents may miss many of the signs. They may not share their feelings about their body with you. They may also exercise, vomit and take laxatives secretly. Low mood may be difficult to spot in an uncommunicative teenager, and lack of interest in sex is not something most parents worry about in their teenage daughters. Good communication and trying to remain open are obviously crucial, but eating habits may be the only easily noted sign. Many sufferers of anorexia develop a detailed knowledge of the nutritional content of foods, including the crucial role of carbohydrates in maintaining body weight, which they avoid. As part of their developing knowledge and interest in food, some sufferers prepare elaborate meals for other people, but eat very little of it themselves. Attempting to miss meals, not eating with the family or visiting the toilet soon after eating may also be reason to be concerned, though they're not conclusive proof of a problem.Read more about eating disorders in Women's health, as well as the bbc.co.uk/news medical notes about anorexia, bulimia and compulsive eating.What support is available?Eating Disorders Association (EDA)
First Floor Wensum House, 103 Prince of Wales Road, Norwich NR1 1DW
Adult Helpline: 0845 634 1414, Monday to Friday 8.30am to 8.30pm.
Youth Helpline: 0845 634 7650, Monday to Friday 4.00pm to 6.30pm.
National Centre for Eating Disorders
54 New Road, Esher, Surrey KT10 9NU UK
Tel: +44 (0)845 838 2040
Anorexia and Bulimia Care
15 Fernhurst Gate, Aughton, Ormskirk, Lancashire L39 5ED
Tel: 01695 422479
What professional help is available?For some people with eating disorders, the condition becomes life-threatening. Under these circumstances, some psychiatrists seek the right to treat the person compulsorily. This is highly controversial. Therapies available on the NHS include:

  • cognitive behavioural therapy (CBT)
  • motivational enhancement therapy (MET)
  • family therapy
  • psychodynamic therapy.

A study of the use of psychotherapy in bulimia - carried out in 1991 with patients followed up after their discharge - found that treatment was more likely to have a lasting effect when it focused on long-term problems in relationships. This supports the idea that many eating disorders may have their roots in low self-esteem.A national centre of excellence for research into this subject is:Eating Disorders Research Unit
Institute of Psychiatry
King's College London, De Crespigny Park, London SE5 8AF
The unit is conducting research into whether genes influence your risk of developing an eating disorder. If more than one member of your family has an eating disorder, they would be interested in hearing from you. Further details at the Institute of Psychiatry.This article was last reviewed in October 2005.
First published in June 2000


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