MEDICATIONS: FREQUENTLY ASKED QUESTIONS: EATING DISORDERS (ANOREXIA AND BULIMIA)

Q:

Why are eating disorders so common among college students?

A:

Problems with eating, including weight gain and weight loss, are common among college students, particularly women. Many parents are surprised to see their college freshman return for the first Thanksgiving break having gained or lost a lot of weight. For some students, this weight change will persist for the rest of that year.

College students live in a world with intense social and educational pressures. Competition is great to look good and be noticed. Many students are away from home for the first time in their lives. Looking great and doing well are highly valued, and the family is not there to counterbalance this pressure.

Q:

Is a person's thinking affected by starvation?

A:

Yes. As you might imagine from the times you have been hungry or thirsty, starvation causes someone to think a great deal about food.

Being preoccupied with food is a normal reaction to hunger, and most people who feel starved will eat. The opposite is true for people with anorexia. Their preoccupation with food does not lead to eating. Instead, it offers an ongoing challenge not to eat, which is one of the ways people with anorexia try to gain control of their lives.

This extraordinary willfulness is characteristic of people with anorexia and can be seen in the way they eat and exercise.

As starvation proceeds, thinking becomes compromised. People with anorexia cannot think clearly or stay focused. They may seem dull and slow. Their ability to understand the relationship between their eating problem and the way they feel can become even more limited. When starvation is severe, a person can lose the ability to make judgments about what they need to survive, such as basic nourishment.

Regaining weight and nutritional rehabilitation are essential elements of the initial treatment of anorexia, and they usually reverse the thinking problems that starvation causes. However, regaining weight and normalizing eating do not improve the emotional problems underlying the disorder. Because these emotional problems cannot be treated successfully when someone is mentally compromised by starvation, treating someone with anorexia must begin with nutritional care.

Q:

How can I talk with someone who has anorexia about her weight problem when she refuses to believe it?

A:

It is hard not to focus on the weight and appearance of a person with anorexia, especially someone you care about who looks so thin and ill. Taking a less direct approach may be necessary, however, because a person with anorexia cannot recognize her weight problem. She looks in the mirror and truly believes she is fat and needs to continue dieting. Although the weight problem may be readily apparent to you, it is not to her. For this reason, you will not be successful if you try to convince someone she has anorexia.

Instead, begin by talking about what matters to her, even if these matters seem small or unimportant to you. Find a way to help the person feel at ease talking with you. Talk about things she takes pride in. It often is easier for someone with anorexia to share her troubles if she doesn't feel pressured and can have some self-respect regarding other parts of her life.

Once an open dialogue is established, you can offer your thoughts about what you see and what you think are some of the problems that weight loss has produced (such as difficulty concentrating and fatigue). Remember that the person with anorexia needs to feel in control, so you don't want to tell her what to do. It is important to convey your caring and concern and your belief that she can take better control of her life in ways that do not cause so much suffering. To do this, the person with anorexia needs professional help, which she must consent to (unless involuntary treatment is required for life-threatening weight loss or chemical imbalances caused by vomiting).

If your encouragement does not work, remember you are not alone and you are not responsible for the person with anorexia. You may need to contact the person's parents, teachers, minister or other friends and share your concerns with them.

The person suffering from anorexia needs to seek professional help. A psychiatrist can help the person with anorexia make the connections between how they feel and the problems they are having with eating. Therapy also can help the person with anorexia find less destructive and more adaptive ways to take control of her life.

Q:

Why do antidepressants sometimes help improve bulimic behavior?

A:

Researchers do not know why antidepressants help people with bulimia, but studies show that sometimes these medications are effective. Some researchers speculate that depression may play a role in bulimic behavior. Others have suggested that newer types of antidepressants help control the impulsive behavior that characterizes bulimia. Fortunately, we can take advantage of an effective treatment, even if we don't know exactly how it works.

Antidepressants are used to treat many illnesses besides depression – including headaches, anxiety conditions and fibromyalgia. They can be prescribed by psychiatrists and by family and primary care physicians.

Antidepressant medications alone are not sufficient treatment for bulimia. Psychotherapy, often combined with nutritional counseling and group training in various interpersonal and emotional skills, is essential for a person to recover from bulimia. 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.