We've come a long way, baby. This might not be your first thought when you hear the term "eating disorders", but in fact we now have a better understanding of what factors contribute to this problem, and better methods of treatment.
Consider this: according to Dr. Rick Bishop of the Eating Recovery Center in Denver, back in the 1970's, "treatment" of anorexia on a psychiatric ward involved strapping the patient into a specialized chair, with a tray of food. The patient stayed there until the food was eaten. As he noted, at some point patients figured out that if they just complied with this for awhile, they'd be released and they could go right back to their anorexic behaviors. Not exactly an effective treatment. Yes, we've come a long way, baby.
Unfortunately, in some ways the problem is worse. Depending on what statistics you believe, the problem of eating disorders is growing and spreading. Boys are now affected more. Younger kids are affected. Thanks to improved medical care, eating disorder patients now live for decades with untreated eating disorders, exacerbating the severity of other chronic diseases in middle age. A local therapist told me she recently saw an 80 year old for eating disorder therapy.
Possibly the most significant change in our understanding of this disease comes from the study of genetics. It's now clear that a great deal of susceptibility to developing an eating disorder depends on genes. For example, genes affect likelihood of developing depression, anxiety and obsessive compulsive tendencies. And those disorders are common for people with eating disorders.
But genes and family history don't doom a person to an eating disorder. Environmental cues, whether from family dynamics or peer pressure, also exert a big influence. Weight loss diets and fashion magazines alone don't cause eating disorders, but those can be toxic triggers for a vulnerable person. And while we no longer blame families, or Mom, for a child's eating disorder, therapy does frequently involve the whole family for at least some of the treatment process.
The biggest misunderstanding most people have is that the eating disorder patient can just stop the behavior if they want, and refusal to do so it just orneriness. This is false. A parent or friend or spouse confronting someone with a spiraling eating disorder is not likely to be successful. Professional help, preferably a team of medical experts, is definitely advisable.
Anorexia may be the most visible eating disorder, and reportedly has the highest death rate of any mental illness. A person may start the downward spiral by dieting, even if not overweight, but then the weight loss just keeps on going. The person may rationalize this weight loss, or try to dismiss it or hide by wearing shapeless clothing. Picky eating becomes a long list of forbidden foods. People may go from vegetarian to vegan diets, as a way to justify the forbidden food list. At meals, the person pushes food around the plate, eats very little, and may conceal or secretly discard the food to avoid critical comments. Some signs that the extreme weight loss is having adverse physical effects include: hair loss, cold intolerance (cold hands and wearing cold-weather clothes, like winter coats, inside are signs), dizziness, loss of menstrual periods in females, fatigue and sleep disturbances.
Bulimia typically involves binge eating enormous amounts of food, followed by purging. The bulimic person may appear normal weight, or overweight, so the obvious outward signs of an eating disorder are absent. Dentists can tell if a person has been vomiting, due to unique patterns of erosion on teeth. Otherwise signs of bulimia may be external clues: empty food containers and bags hidden in the trash, disappearance of entire food packages from the kitchen, sounds or smell of vomiting, empty packages of laxatives, a child who leaves the dinner table quickly and spends an inordinate amount of time in the bathroom (perhaps with water running to mask sounds). One danger of prolonged bulimia is severe electrolyte imbalances from the vomiting, leading to potentially serious metabolic crisis.
Binge Eating Disorder, without purging, is a previously unrecognized diagnosis. Binge eating is getting more attention lately, from researchers and treatment professionals. While binge eating itself can be treated as an eating disorder, there are medical consquences if the binge eating leads to obesity.
A person with an out-of-control eating disorder needs treatment, not judgement or criticism. The Denver area is home to many cutting edge treatment and support options, and during February I'll be writing about some of those. Hopefully, if you have an eating disorder, or know someone who does, this information will be helpful as you investigate treatment plans.
The Eating Disorder Foundation, based in Denver, has a wealth of information about eating disorders, as well as a directory of some of the treatment options in Colorado. Next week, I'll be writing about the EDF's newly opened support center, the first of its kind.
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