Eating Disorders

                                       Ana's Diet Plan

This month’s psychologist’s blog will focus on an issue that is ever growing and kills more people a year than any other mental illness (South Carolina Department of Mental Health, 2012).

Ana.       Mia.

Two girls’ names, right? Yes, but they also refer to Anorexia Nervosa and Bulimia Nervosa, two mental illnesses that kill teenagers daily.  For example, Anorexia Nervosa has a mortality rate of 12 times higher than the death rate for all causes of death for females 15-24 (SC Department of Mental Health, 2012). Then, there are the Pro-Ana and Pro-Mia sites that pop up on the internet. The purpose of these sites is to inform people with eating disorders how to lose more weight, control their hunger, hide their disorders, and find support from other people with eating disorders.  One site even has a “Thinspiration E-Book.” Type in either term to Google and you will find hundreds of sites and pictures featuring very, very thin women. Visit these sites and you’ll get a glimpse into a serious mental illness that is both very difficult and expensive to treat.

Definitions:

Anorexia: “Refusal to maintain a minimal normal body weight, intense fear of gaining weight, distorted perception of  body image, and amenorrhea [no menstrual cycle] in females.” (291-292, Williamson, Bentz, & Rabalais. 1998).

Bulimia: “…uncontrolled binge eating…followed by the use of purgative methods to control weight gain….self-induced vomiting, excessive exercise, restrictive eating, and the use of laxatives and diuretics.” (292, Williamson, Bentz, & Rabalais. 1998).

Some brief statistics on these disorders:

-as many as 11 million Americans have an eating disorder, one million of those being males (National Eating Disorders Association, 2005). These are only the reported cases, numbers are likely higher, especially when one includes binge eating disorder.

-5-10% of Anorexics die within 10 years of developing Anorexia, 18-20% will be dead after 20 years and only 30-40% ever fully recover (SC Department of Mental Health, 2012).

-Population: Caucasian, young, females from upper socio-economic backgrounds (Williamson, Bentz, & Rabalais. 1998). Although not as frequently recognized, males do suffer from eating disorders.

-Both Anorexics and Bulimics develop serious health conditions as a result of their illness. Heart disease, depression, suicidal thoughts or behaviors, absence of menstruation, bone loss, stunted growth, seizures, digestive problems, bowel irregularities, kidney damage, severe tooth decay, high or low blood pressure, type 2 diabetes, and gallbladder disease. (Eating Disorders Overview, Mayo Clinic)

-People with eating disorders often have comorbid conditions of depression and anxiety. One study found that 42.8% of girls with Anorexia were also diagnosed with Major Depressive Disorder at some point (293,Williamson, Bentz, & Rabalais. 1998)

But at what point does a healthy lifestyle of exercise and veggie love turn into a disorder? And why do some people develop eating disorders that last years, and other do not? We don’t really know.

What we do know is that eating disorders are most often seen in highly successfully, highly achieving people, usually in their teens or early twenties. Most people with eating disorders are classic Type A: overachieving, perfectionistic, and anxious. It appears that controlling and restricting food provides a sense of control and calm for these people.

Risk Factors:

Family history of eating disorders, female athletes (particularly those in appearance dependent activities such as cheerleading, gymnastics, and ice skating), upper SES, Caucasian, overachieving, anxious, family that focuses on appearance, and age (teen-20s).

Treatment

Very expensive and difficult. Outpatient therapy (cognitive behavioral or interpersonal) and for Bulimia, antidepressants were proven to be more effective than placebos. However, medications for Anorexia have not been as successful (301,Williamson, Bentz, & Rabalais. 1998). Consultation with a nutritionist is also beneficial .

-1/3 of those with Anorexia receive outpatient therapy (National Eating Disorders Association Statistics).

Dr. Sarah Graves