American Medical Association Family Medical Guide - American Medical Association [466]
• Social Dieting is the No. 1 activity that puts a person at risk for anorexia. Media messages that equate success and popularity with thinness encourage excessive dieting and weight loss, especially in women and girls.
• Environmental Anorexia or bulimia may begin when a vulnerable person responds to a difficult transition—such as enrolling in a new school, starting a new job, getting married or divorced, or breaking up with a boyfriend or girlfriend—by losing an excessive amount of weight or bingeing and purging.
Treatment of eating disorders can save a person’s life. Untreated, anorexia can be fatal. The earlier anorexia and bulimia are treated, the more successful the treatment is likely to be. The recovery rate for people with bulimia is 80 percent when treatment begins within the first 5 years of illness. When treatment is delayed more than 15 years, the recovery rate falls to 20 percent.
Symptoms
Both anorexia and bulimia are characterized by a distorted body image and abnormal eating habits. Many of the symptoms of these disorders are distinct, although many are common to both.
Anorexia
People with anorexia display strange eating habits, including eating in ritualistic ways, chewing food and spitting it out, and shopping and cooking for others while refraining from eating. They may mentally divide foods into good and bad groups, eating only the foods they consider good and eliminating whole categories of foods, such as fat, red meat, or sugar. They often feel superior to people who don’t eat the “right” foods. They may also be depressed, irritable, argumentative, or withdrawn.
They may spend a significant amount of time inspecting their body in a mirror. Some people with anorexia exercise compulsively and excessively. They may engage in irrational thinking (“If I don’t eat this, I’ll feel better.”). As their weight drops, women stop menstruating; adolescent girls may not begin to menstruate, a sign of delayed puberty (see page 448). Hormonal changes may produce downy hair growth on their face, arms, and body.
Bulimia
In contrast to people with anorexia, people who have bulimia have problems with impulse control. In addition to binge eating and then purging the food, people with bulimia may engage in risky behavior. For example, they may shoplift or binge-shop, be sexually promiscuous, or abuse drugs or alcohol. Their weight may be normal or even above normal. Many have underlying feelings of depression, loneliness, shame, or emptiness, although, on the surface, they appear confident and are often fun to be with. Like people with anorexia, many people with bulimia tend to be overly dependent on their families.
Repeated vomiting can rupture the esophagus (the muscular tube that connects the throat to the stomach) and make the salivary glands swollen, which make the cheeks puffy. The backs of the front teeth may be damaged by frequent exposure to regurgitated stomach acid. Some people with bulimia have scars or calluses on the backs of their hands from rubbing them against their teeth when they induce vomiting.
Diagnosis
Getting a person to recognize that he or she has an eating disorder can be extremely difficult. Many affected people deny that they have a problem. If you know someone who has anorexia or bulimia, or if you think you may have one of these disorders, get help right away. The earlier treatment begins, the more successful it can be.
After performing a thorough physical examination to rule out another illness and taking a health history (see page 130), including a family health history, a doctor can usually diagnose an eating disorder by listening to the person’s description of his or her symptoms and evaluating his or her weight and body fat.
Treatment
Once anorexia or bulimia is diagnosed, the doctor must determine whether the person is so ill that he or she needs to be hospitalized. Conditions that justify hospitalization include excessive and rapid weight loss, severe dehydration that could