It is not possible to pinpoint the exact cause of an eating disorder, as there are
so many theories and all of them valid. Whatever the theory, whatever the cause
gathered by a doctor from their patient, it's difficult to know the moment when
a person's eating has become so disordered they have unconsciously decided to head
along a path that can ultimately lead them to death. Parents and loved ones of the
sufferers of eating disorders are always left asking themselves: "What have we done
to make our child hate themselves so much?"
With the highest mortality rate in psychiatric
practice, 10-25% of the victims of eating disorders die from this condition. Those
who survive, but carry on living with the illness, live a life of unbelievable torment.
Eating disorders are medical and psychological enigmas that leave those living with
sufferers no explanation for their incomprehensible, sometimes deceitful behaviour.
What might cause an eating disorder?
The three most common eating disorders are anorexia nervosa, bulimia nervosa and
binge eating. They are complex conditions that arise from a combination of long-standing
behavioural, emotional, psychological, interpersonal and social factors.
Approximately 1% of adolescent girls develop anorexia nervosa while another 2-3%
develop bulimia. A much smaller number of adolescent boys are also developing eating
disorders.
Scientists and researchers are still learning about the underlying causes of these
emotionally and physically damaging conditions. In many cases the eating disorder
is a unique reaction to an excess of external and internal conflicts. We do know,
however, about some of the general issues that can contribute to the development
of eating disorders.
While eating disorders may begin with preoccupations with food and weight, they
are most often about much more than food. People with eating disorders often use
food and the control of food in an attempt to compensate for feelings and emotions
that may otherwise seem overwhelming. People with these disorders often have low
self-esteem and feel an intense need to control their surroundings and emotions.
For some, dieting, bingeing and purging may begin as a way to cope with painful
emotions and to feel in control of one's life, but ultimately these behaviours will
damage their physical and emotional health.
"There may be an acute trigger point," says psychiatrist Dr Sheridan, who specialises
in dealing with anorexia nervosa and bulimia nervosa. "Be it a break-up or a response
to a particular experience, there is always a deep-felt sense of personal insecurity
and a sense of ineffectiveness." Dr Sheridan continues: "If you're drowning, you'll
grab the first piece of wood, even if it takes you out to sea."
A family history of anorexia nervosa may increase the risk of developing anorexia.
So too will a family or personal history of depression. Sexual and/or physical and
emotional abuse are common, though not all people living with eating disorders have
experienced abuse. There also seems to be a connection to depression. The disorder
sometimes causes the depression or the depression can lead to the disorder.
There are many factors that may contribute to eating disorders:
Psychological factors
- Low self-esteem
- Feelings of inadequacy or lack of control in life
- Depression, anxiety, anger or loneliness
Interpersonal factors
- Troubled family and personal relationships
- Difficulty expressing emotions and feelings
- History of being teased or ridiculed based on size or weight
- History of physical or sexual abuse
Social factors
- Cultural pressures that glorify 'thinness' and place value on obtaining the 'perfect
body'
- Narrow definitions of beauty that include only women and men of specific body weights
and shapes
- Cultural norms that value people on the basis of physical appearance
Other factors
Scientists are still researching possible biochemical or biological causes of eating
disorders. In some individuals with eating disorders, certain chemicals in the brain
that control hunger, appetite and digestion have been found to be imbalanced. However
the exact meaning and implications of these imbalances remains under investigation.
Anorexia Nervosa
Anorexia nervosa is an eating problem that occurs when a person is extremely afraid
of becoming overweight regardless of their current weight. Consequently they eat
as little as possible. The condition largely occurs among women but 5-10% of people
with the illness are men.
It is both a physical and psychiatric illness that results in extreme weight loss
- at least 15% below the individual's normal body weight. The vast majority of the
afflicted are adolescents.
According to some studies as many as one in seven women in Australia will become
afflicted by anorexia nervosa at some stage in their lives. In Australia between
1997 and 1998 the hospitalisation rate of females aged between 12 and 24 for anorexia
nervosa was 210 per 100,000 females. The hospitalisation rate among young males
was much lower, with 11 hospitalisations for every 100,000. However there are many
more young people who suffer from anorexia and bulimia but do not require or receive
hospitalisation. There is also a trend to treat anorexia in specialty clinics on
an outpatient or ambulatory basis.
The symptoms
- Refusal to maintain body weight at or above the minimum normal weight for height,
body type, age and activity level
- Intense fear of weight gain or being 'fat'
- Feeling 'fat' or overweight despite dramatic weight loss
- Loss of menstrual periods
- Extreme concern with body weight and shape
Bulimia Nervosa
This is a destructive pattern of over-eating followed by vomiting or other purging
behaviours used to control weight. Sufferers may have days of binge eating, self-induced
vomiting or abuse of laxatives.
It's interesting to note that substance abuse and other forms of destructive behaviour
are common in bulimics and half of the people with anorexia will develop bulimia.
Many individuals' weights remain normal or above because of their frequent binges.
These episodes can occur once or twice a week or a few times a day. Heavy dieting
between purges is common. Friends and family might find it difficult to detect bulimia
in someone they know. A great problem when dealing with bulimia is that a lot of
the sufferers will not get help until they reach their 30s or 40s. They are ashamed
of their strange eating habits, which are difficult to change, and the chaos of
their eating becomes normal to them.
The symptoms
- Repeated episodes of bingeing and purging
- Feeling out of control during a binge and eating beyond the point of comfortable
fullness
- Purging after a binge (typically by self-induced vomiting, abuse of laxatives, diet
pills and/or diuretics, excessive exercise or fasting)
- Frequent dieting
- Extreme concern with body weight and shape
Binge Eating
This is an illness which resembles bulimia nervosa and has only recently been recognised
as a distinct condition. Like bulimics, binge eaters have episodes of uncontrolled
eating. However binge eating disorder differs from bulimia because sufferers do
not purge their bodies of excess food.
These sufferers usually eat large quantities of food and do not stop until they
are uncomfortably full. They often struggle to lose weight and can be obese and
have a history of weight fluctuations. Surprisingly, binge eating is the most common
eating disorder of the three. Most people with this syndrome are obese (more than
20% above a healthy body weight), but normal-weight people can also be affected.
It's more common in women, with three women affected for every two men.
The symptoms
- Known history of depression
- Suffering from negative emotions such as sadness, boredom, anxiety and anger
- Constantly dieting - 'yo-yo dieter'
- Impulsive behaviour and psychological problems
Treatment
Eating disorders are complex conditions that can arise from a variety of potential
causes. Once started, however, they can create a self-perpetuating cycle of physical
and emotional destruction. Eating disorders require professional help.
Treatment is difficult because sufferers often believe there is nothing wrong with
them. Patients in the early stages (less than six months or with just a small amount
of weight loss) may be successfully treated without having to be admitted to hospital.
For successful treatment, patients must eventually want to change and require support
from family and friends. Indeed, watching loved ones suffer can be a trying and
confusing time for all involved and counseling for the entire family is sometimes
recommended.
People with more serious eating disorders may require hospitalisation, usually in
a special unit. Eating disorders generally require an intensive long-term treatment
programme and it is strongly recommended to seek treatment from physicians who are
experienced with eating disorders.
All eating disorders should be treated on both a physical and psychological level.
The team should consist of a doctor to treat the starvation-induced medical problems,
a psychiatrist or psychologist and a dietician. The main issue for the patient is
to find a treatment that is best for her/him and to discuss it with a qualified
healthcare professional.
