Eating Disorders

Source: Anorexia Nervosa and Related Eating Disorders, Inc. - http://www.anred.com

Self Test

Are you at risk? Take a self-test

The following questionnaire can help you decide if you have an eating disorder, or if you are at risk of developing one. The easiest way to take the test is to print it out, circle True or False for each item, and then read the explanatory paragraph at the end.

1. True or False Even though people tell me I'm thin, I feel fat.
2. True or False I get anxious if I can't exercise.
3. True or False [Female] My menstrual periods are irregular or absent.
4. True or False [Male] My sex drive is not as strong as it used to be.
5. True or False I worry about what I will eat.
6. True or False If I gain weight, I get anxious and depressed.
7. True or False I would rather eat by myself than with family or friends.
8. True or False Other people talk about the way I eat.
9. True or False I get anxious when people urge me to eat.
10. True or False I don't talk much about my fear of being fat because no one understands how I feel.
11. True or False I enjoy cooking for others, but I usually don't eat what I've cooked.
12. True or False I have a secret stash of food.
13. True or False When I eat, I'm afraid I won't be able to stop.
14. True or False I lie about what I eat.
15. True or False I don't like to be bothered or interrupted when I'm eating.
16. True or False If I were thinner, I would like myself better.
17. True or False I like to read recipes, cookbooks, calorie charts, and books about dieting and exercise.
18. True or False I have missed work or school because of my weight or eating habits.
19. True or False I tend to be depressed and irritable.
20. True or False I feel guilty when I eat.
21. True or False I avoid some people because they bug me about the way I eat.
22. True or False When I eat, I feel bloated and fat.
23. True or False My eating habits and fear of food interfere with friendships or romantic relationships.
24. True or False I binge eat.
25. True or False I do strange things with my food (cut it into tiny pieces, eat it in special ways, eat it on special dishes with special utensils, make patterns on my plate with it, secretly throw it away, give it to the dog, hide it, spit it out before I swallow, etc.)
26. True or False I get anxious when people watch me eat.
27. True or False I am hardly ever satisfied with myself.
28. True or False I vomit or take laxatives to control my weight.
29. True or False I want to be thinner than my friends.
30. True or False I have said or thought, "I would rather die than be fat."
31. True or False I have stolen food, laxatives, or diet pills from stores or from other people.
32. True or False I have fasted to lose weight.
33. True or False In romantic moments, I cannot let myself go because I am worried about my fat and flab.
34. True or False I have noticed one or more of the following: cold hands and feet, dry skin, thinning hair, fragile nails, swollen glands in my neck, dental cavities, dizziness, weakness, fainting, rapid or irregular heartbeat.

Discussion and Scoring
As strange as it seems in our thin-obsessed society, none of the above behaviors is normal or healthy. Because of unhealthy demands for unrealistic thinness, most women -- and a lot of men -- will check a few of the above items "True." But remember, the more items you have marked True, the more serious your situation may be. Please consult with your physician or a qualified mental health counselor to prevent medical and psychological problems. You could show the person this questionnaire and the items you have circled as a way to begin the conversation.

People do recover from eating disorders, but almost all of those who do, need professional help to get back on track. We know this is hard, and we appreciate your courage as you take the first step by calling today to make an appointment with your physician or counselor.

Anorexia Nervosa: the relentless pursuit of thinness

• Person refuses to maintain normal body weight for age and height.
• Weighs 85% or less than what is developmentally expected for age and height.
• Young girls do not begin to menstruate at the appropriate age. Puberty is delayed in both sexes.
• In women, menstrual periods stop. In men, levels of sex hormones fall. Sex drive disappears or is much diminished.
• Person denies the dangers of low weight.
• Is terrified of becoming fat.
• Is terrified of gaining weight even though s/he is alarmingly underweight.
• Reports feeling fat even when emaciated.

In addition, anorexia nervosa often includes depression, irritability, withdrawal, and peculiar behaviors such as compulsive rituals, strange eating habits, and division of foods into "good/safe" and "bad/dangerous" categories. Person may have low tolerance for change and new situations; may fear growing up and assuming adult responsibilities and an adult lifestyle. May be overly engaged with or dependent on parents or family. Dieting may represent avoidance of, or attempts to cope with, the demands of a new life stage such as adolescence.

Bulimia Nervosa: the diet-binge-purge disorder

• Person diets, becomes hungry, and then binge eats in response to powerful cravings and feelings of deprivation.
• Feels out of control while eating.
• Fears gaining weight and frantically tries to "undo" the binge. Vomits, misuses laxatives, exercises, or fasts to get rid of the calories.
• Swears to "be good," to never binge eat again, but then continues to restrict food intake which starts yet another repeat of the deprivation-hunger-binge-purge cycle.
• Believes self-worth requires being thin. (It does not.)
• May shoplift, be promiscuous, and abuse alcohol, drugs and credit cards. May engage in risk-taking behavior and have other problems with impulse control. Person acts with little thought of consequences.
• Weight may be normal or near normal unless anorexia is also present.

Like anorexia, bulimia can kill. Even though bulimics put up a brave front, they are often depressed, lonely, ashamed, and empty inside. Friends may describe them as competent, glamorous, adventurous and fun to be with, but underneath, where they hide their guilty secrets, they are hurting. Feeling unworthy, they have great difficulty talking about their feelings, which almost always include anxiety, depression, self-doubt, and deeply buried anger.

Binge eating disorder or compulsive overeating

• The person binge consumes large amounts of food frequently and repeatedly.
• Feels out of control and unable to stop eating during binges.
• May eat rapidly and secretly, or may snack and nibble all day long.
• Feels guilty and ashamed of binge eating.
• Has a history of diet failures
• Tends to be depressed and obese.

People who have binge eating disorder do not regularly vomit, overexercise, or abuse laxatives like bulimics do. They may be genetically predisposed to weigh more than the cultural ideal (which at present is exceedingly unrealistic), so they diet, make themselves hungry, and then binge in response to that hunger. Or they may eat for emotional reasons: to comfort themselves, avoid threatening situations, and numb emotional pain. Regardless of the reason, diet programs are not the answer. In fact, diets almost always make matters worse. Information reported in the March 2003 New England Journal of Medicine suggests that for some people, but not all, a genetic flaw in combination with lifestyle factors can predispose to binge eating and subsequent obesity.

Medical and psychological complications of eating disorders
If not stopped, starving, stuffing, and purging can lead to irreversible physical damage and even death. Eating disorders can affect every cell, tissue, and organ in the body. The following is a partial list of the medical dangers associated with anorexia nervosa, bulimia, and binge eating disorder.

• Irregular heartbeat, cardiac arrest, death
• Kidney damage, renal failure, death
• Liver damage (made worse by substance abuse), death
• Loss of muscle mass. Broomstick arms and legs.
• Permanent loss of bone mass; fractures and lifelong problems caused by fragile bones and joints. Osteopenia, osteoporosis, and dowager's hump
• Destruction of teeth, rupture of esophagus, damage to lining of stomach; gastritis, gastric distress including bloat and distension
• Disruption of menstrual cycle, infertility
• Delayed growth and permanently stunted growth due to undernutrition. Even after recovery and weight restoration, person may not catch up to expected normal height.
• Weakened immune system
• Icy hands and feet
• Swollen glands in neck; stones in salivary duct, "chipmunk cheeks."
• Excess hair on face, arms, and body. Long, downy lanugo hair. May be emaciated body's attempt to be warm.
• Dry, blotchy skin that has an unhealthy gray or yellow cast
• Anemia, malnutrition. Disruption of body's fluid/mineral balance (electrolyte imbalance, loss of potassium; can be fatal)
• Fainting spells, seizures, sleep disruption, bad dreams, mental fuzziness
• Low blood sugar (hypoglycemia), including shakiness, anxiety, restlessness, and a pervasive itchy sensation all over the body.
• Anal and bladder incontinence, urinary tract infections, vaginal prolapse, and other problems related to weak and damaged pelvic floor muscles. Some problems may be related to chronic constipation, which is commonly found in people with anorexia nervosa. Structural damage and atrophy of pelvic floor muscles can be caused by low estrogen levels, excessive exercise, and inadequate nutrition. Surgery may be necessary to repair the damage.

Because of changes in the brain associated with under-nourishment, binge eating, and purging, the person does not, and perhaps cannot, weigh priorities, make judgments, and make choices that are logical and rational for normal people. Recovery, once the process has begun, requires time for the brain to readjust -- chemically and physically -- to normal and healthy patterns of eating. This is a combined physical/psychological problem.

If binge eating disorder leads to obesity, add the following:

• Increased risk of cardiovascular disease
• Increased risk of bowel, breast, and reproductive cancers
• Increased risk of diabetes
• Arthritic damage to joints

Dieting risk
In one study, researchers asked women to reduce their caloric intake by 50%. After 15 weeks, the activity of their natural killer cells (a part of the immune system that combats viruses) fell 20%. (Health magazine, 1999)

The curse of washboard abs: women with well-defined belly muscles
Women with well-defined belly muscles may have as little as six percent body fat. The healthy range is 15-23 percent. Menses stop when fat falls below ten percent. The associated low levels of estrogen can lead to osteoporosis, even in 20-year-olds. Is a rippling stomach worth a dowager's hump? (Lew Lyon, exercise physiologist. Reported in Newsweek, May 5, 1997)

Psychological Problems
As painful as the medical consequences of an eating disorder are, the psychological agony can be worse. It is a sad irony that the person who develops an eating disorder often begins with a diet, believing that weight loss will lead to improved self-esteem, self-confidence, and happiness. The cruel reality is that persistent undereating, binge eating, and purging have the opposite effect. Eating disordered individuals typically struggle with one or more of the following complications:

• Depression that can lead to self-harm and suicide
• Person feels out of control and helpless to do anything about problems
• Anxiety, self-doubt
• Guilt and shame, feelings of failure
• Hypervigilance. Thinks other people are watching and waiting to confront or interfere.
• Fear of discovery
• Obsessive thoughts and preoccupations
• Compulsive behaviors. Rituals dictate most activities.
• Feelings of alienation and loneliness. "I don't fit in anywhere."
• Feels hopeless and helpless. Cannot figure out how to make things better. May give up and sink into despair, fatalism, or suicidal depression.

Because of changes in the brain associated with under-nourishment, binge eating, and purging, the person does not, and perhaps cannot, weigh priorities, make judgments, and make choices that are logical and rational for normal people. Recovery, once the process is begun, requires time for the brain to readjust -- chemically and physically -- to normal and healthy patterns of eating. This is a combined physical/psychological problem.

Related Problems
Eating disorders bring pain and suffering not only to the people who have them but also to their families, friends, and romantic partners. Coworkers and even casual acquaintances can be affected too. These problems include the following:

• Disruption of family. Blame, fights over food, weight, treatment, and so forth.
• Family members struggle with guilt, worry, anxiety, and frustration. Nothing they do seems to make things better.
• Friendships and romantic relationships are damaged or destroyed. Person with the eating disorder is, or becomes, emotionally cool and withdrawn, crabby and cranky, minimally or not at all interested in sex, and secretive and controlling, often in a passive/aggressive manner.
• If person binges and purges while driving (yes, some people do that), auto accidents may be the result of distraction.
• If person is a student or athlete, teachers, coaches, and trainers may experience the same worry and frustration that plagues family members.