American Medical Association Family Medical Guide - American Medical Association [465]
Interpersonal psychotherapy can help binge eaters look at their relationships with family members and friends to find ways to improve their social interactions and relationships. Self-help groups offer a source of encouragement and allow people to share useful information and their experiences and ways of overcoming their problem. Some people with a binge eating disorder may also benefit from antidepressant medications (see page 712) if depression is a factor. Working with a registered dietitian, binge eaters can develop a sensible eating plan that emphasizes healthy foods, along with a program of regular exercise to help them lose weight gradually and keep it off.
Anorexia and Bulimia
Anorexia nervosa is a life-threatening eating disorder whose distinguishing features are self-starvation and excessive weight loss. People with anorexia have an irrational fear of gaining weight and a distorted perception of their appearance, believing that they are fat when, in reality, they are extremely thin. They are at a much lower weight than the healthy weight for their height, body type, and level of activity. They consider being thin a unique achievement that gives them some control over at least one part of their lives. Anorexia can cause permanent physical and psychological problems, including the bone-thinning disorder osteoporosis, infertility, heart attack, and depression.
Anorexia most often starts between the ages of 12 and 25 years and affects women and girls more frequently than men and boys. About 10 percent of people with anorexia are male. Doctors think that this gender disparity reflects the intense pressure society places on women to be thin. Roughly 1 percent of adolescent girls have anorexia.
Bulimia nervosa also is a serious disorder that can be life-threatening. Bulimia is characterized by a secretive cycle of binge eating and then purging the body of the food, usually by self-induced vomiting. People with bulimia consume massive quantities of food in a short period of time, ignoring feelings of fullness. During binges, they often feel that their eating is out of control. Such binges make the person worry about gaining weight and trigger the need to compensate by eliminating the food from the body through vomiting or using laxatives (drugs that eliminate solid wastes from the body) or diuretics (drugs that eliminate water from the body). They may often fast, exercise excessively, or use diet pills. Like people with anorexia, people who have bulimia are acutely aware of their body weight and shape. Four percent of all college-age women have bulimia, and half of all people who have anorexia also develop bulimia.
A combination of factors is responsible for the development of anorexia or bulimia, and any given factor may be more or less important for a particular person. The following are the most significant contributing factors:
• Biological Eating disorders sometimes run in families, and family members of people with eating disorders have a high risk of developing one themselves. For example, a person whose mother or sister has anorexia is 12 times more likely than average to have the disorder. Over time, the disordered eating pattern changes the person’s brain chemistry, producing euphoric feelings that reinforce the eating disorder.
• Psychological Some personality types, such as perfectionists, are more prone to having anorexia. People with anorexia have certain shared characteristics. They tend to be conscientious and hardworking. They are good students or employees who try to please, seek approval, and avoid conflict.
In spite of this, they often feel inadequate and powerless, and try to take control of their lives by controlling what they eat. Affected adolescents sometimes fear growing up and taking on adult responsibilities.
• Family-related The families of some people with anorexia or bulimia may be overprotective and inflexible. Some families may overvalue physical appearance or make disparaging remarks about their