A CLOSER LOOK AT EATING DISORDERS

Most people know my name and recognize my face. I'm a supermodel. What most people don't know is that I am recovering from an eating disorder. Almost all models today are very thin. Early in my career, just like most of the other models I worked with, I was on a strict diet. At some point, though, my diet turned into something else – an eating disorder. I started to allow myself less and less food, eventually eating only a salad or piece of fruit all day. I continued to exercise every day. I lost 20 pounds. And I still thought that I was too fat. Now I know that I was not seeing my body realistically when I looked in the mirror. Other people thought that I was getting much too thin, but all I saw was fat – fat on my stomach, legs and arms. I even thought my face looked fat. So I continued to try to lose weight by eating little and exercising a lot. Soon I noticed changes about my body. I stopped having my period. My hair got brittle and started to fall out. I had dark circles under my eyes. I was always exhausted. I was often dizzy and my heart beat very fast at times. These symptoms worried me, but I continued to diet and exercise because I still looked in the mirror and thought I looked fat. My friends and family members started to get worried about me. I denied having a problem; after all, it is not uncommon for models to diet and exercise. I found myself lying to my friends and family members about how much I ate. I told myself that they just did not understand how much weight I needed to lose to be a good model. I pretended that I was happy and healthy. In reality, I was depressed and starting to get scared about my health. Finally, my mother and sister did something that changed and probably saved my life. They confronted me about my eating disorder and told me I had to go see a doctor. I thought I had convinced them that I was healthy. What I didn't realize is that no one who is 5'10" and weighs 96 pounds looks healthy. When I first went to my family doctor, she explained to me how sick I was, that I could even die if I continued to limit my eating. She referred me to a psychiatrist who specializes in eating disorders. Since then, I have been working with the psychiatrist, my family doctor and a nutritionist. Recovery has been a long process. I still have a long way to go, but I have gotten better about seeing my body in a realistic way and eating a healthy diet. In therapy, I have come to understand why I developed this disorder and how I can prevent it from coming back. Admitting that I have an eating disorder and seeking treatment has been the biggest challenge I have ever faced.

What Is an Eating Disorder?

People with eating disorders are obsessed and struggle daily with their weight and the way their bodies look. If you have an eating disorder, your eating habits and the ways you try to control your weight are unhealthy. There are two main types of eating disorders: anorexia nervosa (often called anorexia) and bulimia nervosa (often called bulimia).

How Do I Know if I Have Anorexia?

People with anorexia have a powerful fear of gaining weight, even though they are actually underweight. If you have anorexia, you do not see your body in a realistic way. You look at your body and see fat, while to others you look much too thin.

"When my daughter got down to 90 pounds, her shoulder and rib bones were protruding. I pleaded with her to look in the mirror to see how she was destroying herself, but all she could see was fat." -Mother of an anorexic college student

Some people with anorexia limit the amount of food they allow themselves to eat. This is called restricting anorexia nervosa. Others force themselves to vomit or use laxatives, enemas or diuretics (pills or other preparations that cause fluid weight to be lost through excessive urination). This is called binge-eating/purging anorexia nervosa.

People with anorexia may have many of these symptoms:

· Refusal to maintain weight at a normal weight for height and age

· Intense fear of weight gain

· Unrealistic or distorted ideas about how one's body looks

· Strange behavior around meals, including rituals

· Going to the bathroom right after meals to vomit

· Missing menstrual periods

· Withdrawing emotionally from people

· Anxiety around meal times

How Do I Know if I Have Bulimia?

People with bulimia binge eat (eating more in a certain time period than most people would eat in that period) and then use some method to try to prevent themselves from gaining weight. Binge eaters feel a lack of control over what they eat or how much they eat.

If you have bulimia, you might use any of the following methods to try to prevent weight gain after binging:

· Forcing yourself to vomit

· Taking laxatives, diuretics or enemas

· Fasting, or not eating at all, for a period after the binge eating

· Exercising too much

Similarly to people with anorexia, people with bulimia are overly concerned with their weight and body shape. Unlike those with anorexia, however, most people with bulimia are of normal weight.

"Whenever I start to feel depressed or bad about myself, I lose control and eat for hours without stopping. Afterwards, I feel terrible, both physically and emotionally. I can imagine all of the calories I just ate turning into fat all over my body. So I force myself to throw up, and then I exercise extra hard the next few days. Each time, I swear that it will never happen again – but it always does." -Teenage girl suffering from bulimia

 

People with bulimia may have many of these symptoms:

· Physical weakness

· Irritability

· Abdominal problems, such as discomfort, vomiting, constipation, bloating or irregular bowel movements

· Mouth and throat problems, such as tooth decay, throat pain or swollen cheeks and neck

· Fertility problems

· Rapid or irregular heartbeat

Who Gets Eating Disorders?

While anyone can develop an eating disorder, anorexia and bulimia are seen most commonly among certain groups.

· Women and girls are more likely to have an eating disorder than men and boys.

· Most often, people develop eating disorders while they are in their teens or early 20s.

· In the United States, eating disorders are more common among young Caucasian, Hispanic and Native American women, and less common among African American and Asian women.

· Certain groups of competitive athletes (such as female long distance runners and gymnasts and male bodybuilders) are more likely to develop eating disorders.

· Many individuals with eating disorders also suffer from another psychiatric illness, such as depression, obsessive-compulsive disorder, substance abuse, anxiety or personality problems. People with eating disorders often report a history of psychological, physical and/or sexual abuse.

How Are Eating Disorders Treated?

Recovering from an eating disorder is difficult and takes time. You will probably need to work with your psychiatrist for many years to develop a healthy body image and eating habits. Without treatment, eating disorders can cause permanent damage to your body, impair your work and social life, and they can even lead to death.

Seeing a psychiatrist and being diagnosed
Seeking treatment for an eating disorder can be scary. It helps to know what to expect when talking to a psychiatrist and getting treatment.

Usually, a psychiatrist will diagnose you and determine what treatments will be helpful. Other health care professionals may work as a team with your psychiatrist to provide nutritional counseling, family therapy, individual and group therapy and skills training.

The psychiatrist will ask you many questions about how you act and feel. Some will be specific questions about your eating patterns and how you think of your body. Others will be more general questions about your overall physical and mental health. The psychiatrist may also ask about eating disorders or other emotional illnesses in your family, and how your family members feel about eating, exercise and appearance.

The psychiatrist may want to watch you eat a meal. While this may be difficult for you, it is important for the psychiatrist to see the way you eat.

Your psychiatrist may work closely with your family or primary care physician, who may do a physical exam. This could include the physician examining your body, listening to your heart, taking your blood pressure and weight, and taking blood and urine tests. A dentist may also need to look at your teeth for damage caused by vomiting.

Health care professionals also may work with your family members to help them understand and cope with your eating disorder in a supportive way.

"The first time I spoke to a psychiatrist about my eating disorder, I was terrified. It was hard enough to admit to myself that I had a problem, much less tell a stranger about it. But, as difficult as it has been to start treatment, it also feels good to share my thoughts and feelings and to find out that there are other people who feel the same way I do – people who have recovered." -Young woman beginning treatment for an eating disorder

Getting treated for an eating disorder
Most people with eating disorders can be treated as outpatients, living at home but participating in a carefully planned treatment program. Others might spend much of the day in a hospital, but spend nights at home (called a partial hospital program). Some people may benefit from living for a period of time in a halfway house that provides support and supervised meals. At times, full-time hospitalization may be necessary to meet the physical and emotional needs of those with eating disorders.

Treatment for anorexia and bulimia begins with nutritional rehabilitation.

If you have anorexia, the goals of nutritional rehabilitation are to help you:

· Return to a healthy weight

· Bring your eating patterns back to normal

· Feel hungry and full in a normal way

· Improve the physical and mental problems caused by anorexia

Your health care team will monitor you carefully to make sure your body is reacting in a healthy way to the "refeeding." In some cases, liquid food supplements are used instead of solid food. In rare cases, when people refuse to eat and their health is seriously at risk, they might be fed intravenously or through a nasal tube. Over time, the health care team helps you maintain balanced nutrition and a healthy weight.

If you have bulimia, the goals of nutritional rehabilitation are to help you:

· Reduce binge eating and purging

· Minimize the number of foods you consider "off limits"

· Increase the variety of foods you eat

· Exercise in a healthy way

Most nutritional rehabilitation programs provide support and education to help people with eating disorders with their fears about weight gain and to change the way they see their bodies.

Psychotherapy is an important treatment for people with eating disorders. Psychotherapy is a series of private talks with a psychiatrist where a person discusses the feelings, thoughts and behavior that cause difficulty. The goal of psychotherapy is to help people understand and master their problems so they can function better. Psychotherapy helps you:

· Understand and participate in nutritional rehabilitation

· Understand and change the behaviors, self-image, and other problem attitudes related to the eating disorder

· Improve the way you feel and act with other people

· Address other psychiatric illnesses and psychological problems that may exist

Family therapy or couples therapy might be used to help heal and improve relationships with family members. Support groups and 12-step programs can help prevent a person who is recovering from an eating disorder from relapsing into unhealthy behaviors.

Finally, studies show antidepressant medications can help reduce binge eating and purging for people with bulimia. These medications should be part of a comprehensive treatment plan. Antidepressants generally are not used for people with anorexia during nutritional rehabilitation.

Review

People with eating disorders are obsessed with their weight and the way their bodies look. Both their eating habits and the way they try to control their weight are unhealthy. Without treatment, eating disorders are dangerous and can even be deadly. With treatment and the help of a psychiatrist, however, person with eating disorders can change their unhealthy behaviors, understand and change the thoughts and attitudes that led to their eating disorders, regain their lost lives, and prevent relapses in the future.

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