Historical milestones for eating disorders

WHAT IS AN EATING DISORDER ?

Eating disorders develop as outward signs of inner emotional or psychological distress or problems. They become the way that people cope with difficulties in their life.  Without appropriate help and treatment, eating problems may persist throughout life.

Eating disorders are complex illnesses where both the disturbed eating pattern as well as the psychological aspects need to be treated. It is important to restore a regular eating pattern plus a balanced diet. Helping someone come to terms with the underlying emotional issues enables them to cope with difficulties in a way that is not harmful to them.

WHO GETS AN EATING DISORDER?

Anyone can develop an eating disorder regardless of age, race, gender or background. However, young women living in industrialized societies are most vulnerable, particularly between the ages of 15-25 years.

Research suggests that a person's genetic make up may make them more likely to develop an eating disorder. As well as biological reasons, a key person - a parent, relative, friend or role mode - may influence others to adopt his or her attitudes to food & eating. In situations where there are high academic expectations or social pressures, a person may focus on food and eating as a way of coping with these stresses.

Traumatic events may trigger anorexia or bulimia nervosa: bereavement, being bullied or abused, upheaval in the family (such as divorce) or concerns over sex or sexuality.

A NATION OF DIETERS

Studies have consistently found that children imitate prosocial behaviour: altruism, helping, delay of gratification & positive interaction with others.

·               More than one third of all the people in the UK are on a diet

·               In a recent survey, 60% of all 16 year olds thought they were too fat.

·               In the same survey, 20% admitted to skipping a meal to keep their calories down.

ANOREXIA NERVOSA

'Anorexia nervosa' means 'loss of appetite for nervous reasons' but this is misleading because there is no loss of appetite. It is an illness that mainly affects adolescent girls although it can occur both in boys or girls younger or older than this. The most common features are loss of weight coupled with a change in behaviour. The weight loss is slowly progressive and often starts with a perfectly normal weight reducing diet. It may only be after this has continued for several months that it seems a cause for worry, usually because by then the weight loss is extreme. To start with the girls are single minded in their determination to lose weight. Attempts to frustrate their efforts are generally met with anger or deceit or a combination of both. Confrontation, rational discussion, bullying or bribery will probably fail to cause more than a very brief change of eating behaviour. Continuing weight loss will lead to increasing concern by the family. A girl of average height will probably be unable to continue at school once her weight falls below around six stones. She will usually begin to lose contact with her friends and may appear to lose interest in everything apart from food and academic work. She may show increased obsessional behaviour especially in the kitchen where she may become concerned with cleanliness, orderliness and precise timing of meals. She may well wish to cook for the family and appear to encourage them to overeat. She may become less assertive, less argumentative and more dependant. At the same time her behaviour will increasingly control the lives of all around her. They may focus on food in an attempt to cope with life. It may be a way of demonstrating that they are in control of their body weight and shape.
Ultimately, however, the illness itself takes control and the chemical changes in the body affect the brain and distort thinking, making it impossible for the person to make rational decisions. As the illness progresses, many people will suffer from the exhaustion of starvation. More than 10% of anorexics will die from starvation, electrolyte imbalance or suicide.

There are some aspects of cause that are unknown. From what we do know it seems that this is a disorder of many causes that come together to produce the illness. These recognised ingredients include the nature of the personality of the girl herself, aspects of her family its members and relationships, and stresses and problems occurring outside home, often at school. There is an increased risk in families in which there are other anorexics and this probably indicates a genetic predisposition also. The trigger is often weight loss from any cause, the most usual being a normal weight reducing diet to lose 'puppy' fat.

The personalities of the girls tend to be conformist, compliant, and hard working. They are often popular with teachers and may have seemed to be little cause for worry over the years. They tend to be mildly obsessional. They are organised and tend towards tidiness. These traits may be quite marked before the onset of anorexia but they are usually accentuated by the disorder.

Family relationships are liable to be strained by the illness even if they have seemed previously good. The families of anorexics are often high achieving with high expectations of their children. The anorexic seems excessively willing to accept this value structure, setting standards for herself that seem extreme. A sense of fun, an enjoyment of being unconventional, and a tolerance of alternative values may seem to be missing from her world. She may seem to over identify with her mother especially and this distorts her relationship in ways too complicated to describe this limited text.

In the year or so that precedes the start of anorexia there is often an increase in the problems or pressures that create anxiety or unhappiness. These frequently seem to be from the school environment because of the common age group of the girls. Typical stresses are the build up towards taking G.C.S.E. and 'A' level exams and feelings of rejection arising from difficulties with relationships with girls or boys.

PHYSICAL SIGNS OF ANOREXIA

• In adults, extreme weight loss; in children & teenagers, poor or inadequate weight gain
• Disrupted menstrual cycles
• Loss of interest in sex
• Loss of bone mass and eventually osteoporosis (brittle bones)
• Dizzy spells and fainting
• Downy hair on the body; loss of hair on the head when recovering
• Poor blood circulation and feeling cold
• Dry, rough, discoloured skin

PSYCHOLOGICAL SIGNS OF ANOREXIA

• Intense fear of gaining weight, even within the normal weight range according to height, age & gender

• Distorted perception of body shape or weight
• Denial of the existence of a problem
• Changes in personality and mood swings

BEHAVIOURAL SIGNS IN ANOREXIA

• Restricted diet
• May use self-induced vomiting, take laxatives and/or appetite suppressants in an attempt to prevent weight gain
• Rituals attached to eating, such as cutting food into tiny pieces
• Secrecy

• Wearing big baggy clothes

THE LONG TERM EFFECTS OF ANOREXIA

The long-term effects of anorexia on the body and mind can be alarming and severe. Women with anorexia tend to find it more difficult to become pregnant and there is the possibility of developing osteoporosis later in life. Fortunately, many of these effects can be reversed - once the body receives proper and regular nourishment.

Danger from a failing heart becomes a risk at very low weights, below around five stones, if the weight loss is extremely rapid, or if the chemistry is distorted by an extreme of vomiting, purging, or diuretic (water tablet) abuse. It is hard to assess a dangerously low weight but sudden death will more frequently occur once the weight has fallen by forty per cent of normal. In practice this often means somewhere near five stones.