Facts about anorexia and bulimia

Bron : http://www.rcpsych.ac.uk/info/help/anor/index.htm

The campaign to increase the understanding of mental health problems and reduce their [stigma] and discrimination.

They say size isn't important. But when does a girl become a woman? Is it when she is seventeen? Or when she has her first kiss? No, it is when she no longer looks like a girl. But that isn't all of it.
A woman is woman-sized. She is also mature, responsible, motherly, caring, supportive, submissive, strong, reliable, successful, sensual, compassionate, kind, sensible and … that is a bit much when you are forty let alone fourteen. No wonder it takes time to grow into and come to terms with the shape that nature has given you

It can be a problem discovering what sort of woman-sized woman to be. It is not just about being fat or thin. It is about being gay or straight, or a mother or a daughter, working, playing, anything that makes life what it is. It is about control of your impulses and destiny.

Sometimes it seems impossible to control all this. Or if you do everything might go wrong. You might not fit anymore and everything will fall apart.

One way of coping is to develop an eating disorder. The girl who starves herself to a low weight shows desperate determination. She knows exactly what she needs to be. Child-sized. But she can’t be eleven forever. Her body is growing. The world is moving on and expecting her to come with it. It becomes irresistible. Maybe she will eat, but she will vomit until she is happy to be woman-sized.

1. Anorexia and bulimia
This girl thinks Marilyn Monroe is great. She hates Kate Moss. She thinks Kate Moss is thinner than she is.
The girl with anorexia is convinced that she is fat even though she is not. She is so fixed in this belief that it seems like she is being stubborn, or stupid. In fact she has her back to the wall.

She has to be the thinnest person in the world. It’s the only way she can survive. She’s on a knife edge. Too fat and she has to face the world. Too thin and she dies. Being in the world is so awful she would rather die.


2. Anorexia and bulimia
This girl would rather die than eat a cheese sandwich. It’s not that she isn’t hungry. She is starving. It’s that if she eats she will put on weight. If she puts on weight she will go totally out of control. She will grow and grow and grow. And everything that she is terrified of will happen.
The girl with anorexia nervosa doesn’t have a problem with being fat. She has a problem with being woman-sized. Becoming a woman means growing up, leaving home, trying to have relationships but not rupturing family links. This is frightening for everyone. For her it is petrifying. Starving makes time stand still.


3. Anorexia and bulimia
If this girl thought she was going to put on weight she would throw up. She wants to be thin. She wants to eat.
Women with bulimia binge and may then vomit. They feel they cannot control life. They are taken over by the urge to eat. They cannot stop themselves. So they make themselves sick. If they didn’t, they’d get fat and they couldn’t bear that.

The girl with bulimia is in a no-win situation. She has two intense and conflicting desires. Vomiting is the only way she can either protect her low weight, if she has anorexia nervosa, or avoid becoming really fat if she has bulimia nervosa.


4. Anorexia and bulimia
If you are what you eat then this girl is nothing. She used to eat a bowl of cereal a day. Now she can manage half a carrot. When she starves herself she is somebody.
Her behaviour fills those around her with fear and frustration. They cannot understand why she won’t eat. They say, ‘It’s easy, all you have to do is pick up a knife and fork’.

She can’t get them to understand. It is hard to explain the fear she has. How can she tell them she would rather die than be a normal adult weight and shape?


5. Anorexia and bulimia
When she looks in the mirror this girl sees a fatty. She is blind to the hip bones and the ribs. She sees the slightly swollen belly. The bud of a breast. The curve of a thigh.

And they disgust her. As she disgusts herself when she eats a cream cake. As they make her want to be sick. Or hide. Under huge jumpers, massive coats. Invisible and shrinking under layers of cloth.

As she jogs on the spot she mutters her mantra: 'when I don't eat I am in control', 'when I am thin I am safe'.



What are anorexia and bulimia?
Anorexia nervosa and bulimia nervosa are the two main eating disorders. People with anorexia have extreme weight loss as a result of very strict dieting. Some people may also make themselves sick, abuse laxatives or do excessive exercise to try and lose weight. In spite of this extreme weight loss, people with anorexia believe they are fat and are terrified of becoming what is in fact a normal weight or shape. About four out of ten people with fully established anorexia make a full recovery, and others improve. Only about three in ten continue to have major long-term illness. Untreated, about 15 per cent of all sufferers will die from the disorder within 20 years of its onset.

People with bulimia nervosa crave food and binge eat, though they are not emaciated. Afterwards they make themselves sick or misuse laxatives to get the food out of their bodies. Sufferers are very afraid of becoming fat.

Who has anorexia or bulimia?

Anorexia nervosa most commonly starts in the mid-teens. About one in a hundred 16 to 18 year olds has the illness. It is much more common in girls. Bulimia nervosa usually starts when people are a little older, but is again more common in girls. Bulimia is more common than anorexia, although people with anorexia in particular do not always ask for treatment.

Occasionally men develop eating disorders, but anorexia nervosa is rare. Male development in puberty is very different from that of females. Related bodily concerns are different and less often lead to the extremes of dieting which commonly precede anorexia nervosa.

What causes eating disorders?

Eating disorders may develop partly in response to difficult life experiences such as abuse or social pressures arising in puberty and in growing up. They are also more common in cultures where it is considered desirable to be slim. Genetic factors seem to be important, especially in anorexia. Sometimes people with an eating disorder are depressed, and they may have obsessions.

What treatments are available?

Mental health professionals need a variety of skills to treat people with eating disorders. A doctor can help diagnose the illness and any associated physical problems resulting from it. In both anorexia nervosa and bulimia, self-help strategies can be very helpful. If this approach does not work, health professionals may suggest a course of psychotherapy. If someone has lost a dangerous amount of weight, the first step will be to help the person start to regain that weight in order to survive. Some people with anorexia may need to be admitted to hospital and the nursing staff has an important role in supporting the patient in the early stages of treatment. Psychological and psychotherapy skills are also necessary at this acute stage, so that the mental health team can begin to understand why the illness developed and how to help the person to overcome it.

In anorexia, this talking treatment will involve the individual with the illness and sometimes other family members. The long-term aim will be to help that person change their attitude, behaviour and ways of thinking, and enable them to cope with the strains of life without the illness as a protection. Shorter-term expert talking treatments and also specific cognitive behavioural treatments are often effective with bulimia nervosa.

What can society do?

We can strive better to understand the distress that underlies and drives these disorders. We can provide access to such information and develop health promotion campaigns aimed at teenagers and young people. Information on how to cope with feelings and fears about growth or about being too fat is useful. We can offer more support in secondary schools and user-friendly services for troubled teenagers.


Other facts ?

Everybody eats. We do so both because we need to and because we enjoy it. However, as with all human behaviour, there are huge differences between people. Some eat more, some eat less, some put on weight easily, others do not. And some people go to such extremes that they harm themselves, by eating too much or too little. As a result they may harm their health and come to the attention of doctors. This leaflet deals with anorexia nervosa and bulimia nervosa.

Although it is easier to talk about them as different conditions, individual patients often suffer from symptoms of both. Indeed, it often happens that bulimia develops after a period of months or years of anorexic symptoms.

Women suffer from these disorders 10 times as often as men, and so this leaflet refers to the sufferer as 'she'. Although often thought of as adult problems, these disorders most often start in the teenage years while the sufferer is still at home


Fear of fatness
Excessive loss of weight
Vigorous exercise
Monthly periods stop

Anorexia usually starts in the mid-teens and affects 1 fifteen-year-old girl in every 150. Occasionally it may start earlier, in childhood, or later, in the 30s or 40s. Girls from professional or managerial families are perhaps more likely to develop it than girls from working-class backgrounds. Other members of the family have often had similar symptoms.

Nearly always, anorexia begins with the everyday dieting that is so much a part of teenage life. About a third of anorexia sufferers have been overweight before starting to diet. Unlike normal dieting, which stops when the desired weight is reached, in anorexia the dieting and the loss of weight continue until the sufferer is well below the normal limit for her age and height. The tiny amount of calories that she is taking in may be disguised by the quantities of fruit, vegetables and salads that she eats. Also, she will often exercise vigorously or take slimming pills to keep her weight low. Moreover, in spite of her own attitude to eating, she may take an avid interest in buying food and cooking for others.

Although technically the word anorexia means 'loss of appetite', sufferers with anorexia actually have a normal appetite, but drastically control their eating.

As time wears on, however, the teenage girl with anorexia may also develop some of the symptoms of bulimia. She may then make herself sick or use laxatives as ways of controlling her weight. Unlike sufferers from 'pure' bulimia, her weight will continue to be very low.


Fear of fatness
Normal weight
Irregular periods
Vomiting and/or excessive use of laxatives

This condition usually affects a slightly older age group, often women in their early to mid-twenties who also have been overweight as children. It will affect 3 out of every 100 women at some time in their lives. Like anorexics, people with bulimia suffer from an exaggerated fear of becoming fat. Unlike women with anorexia the bulimic woman usually manages to keep her weight within normal limits. She can do this because, although she tries to lose weight by making herself sick or taking laxatives, she also 'binge eats'. This involves eating, in a very short time, large quantities of fattening foods that she would not normally allow herself. For example, she might get through numerous packets of biscuits, several boxes of chocolates and a number of cakes in two hours or less. Afterwards she will make herself sick, and feel very guilty and depressed. This bingeing and vomiting may raise or lower her weight by up to 10Ib within a very short period of time. It is extremely uncomfortable, but for many it becomes a vicious circle that they cannot break out of. Their chaotic pattern of eating comes to dominate their lives.

Starvation: Vomiting: Laxatives:
Broken sleep
Difficulty in concentrating or thinking straight
Feeling the cold
Brittle bones which break easily
Muscles become weaker - it becomes an effort to do anything
Stomach acid dissolves the enamel on teeth
Puffy face (due to swollen salivary glands)
Irregular heartbeats
Muscle weakness
Kidney damage
Epileptic fits
Persistent tummy-pain
Swollen fingers
Damage to bowel muscles which may lead to long-term constipation

There are many different ideas about the causes of these two disorders and it is important to stress that not all will apply to every sufferer.

Social Pressure

In societies which do not value thinness, eating disorders are very rare. In surroundings such as ballet schools, where people value thinness extremely highly, they are very common. Generally in Western culture 'thin is beautiful'. Television, newspapers and magazines are full of pictures of slim, attractive young men and women. They push miracle diets and exercise plans to enable us to mould our bodies to the pattern of these artificial, idealised figures, to conform to the shape the media tell us we should be. As a result, almost everybody diets at some time or other! It is easy to see how this social pressure might cause some young women to diet excessively and eventually to develop anorexia.


It has to be said that dieting can be a very satisfying activity. Most of us know the feeling of achievement when the scales tell us that we have lost a couple of pounds! It is good to feel that we have managed to control ourselves in a clear, visible way. It can be especially satisfying for girls in their teens who may often feel that weight is the only part of their lives over which they do have any control. So it is easy to see how dieting can become an end in itself, rather than just a way of losing weight.


A girl with anorexia may lose or not fully develop some of the physical characteristics of an adult woman, such as pubic hair, breasts and monthly periods. As a result, she may look very young for her age. Dieting can therefore be seen as a way of putting off some of the demands of maturing, particularly the sexual ones. Unfortunately, this condition makes it difficult for her to develop the maturity and self-awareness that come from facing and dealing with the problems of growing up.


Eating is a most important part of our lives with other people. Accepting food gives pleasure to whoever is providing it, refusing it will often cause offence. This is particularly true within families! Some children and teenagers seem to find that saying no to food is the only way they can either express their feelings or have any influence in the family


Most of us are familiar with the experience of eating for comfort when we are upset, or even just bored. Many sufferers with bulimia have depressive symptoms and it may be that their binges started off as a way of coping with feeling unhappy. However, feeling stuffed and bloated will make these feelings worse, while vomiting and purging leave a feeling of guilt and wretchedness.


We all have different ways of reacting to the bad things that happen to us in life. For some people, anorexia or bulimia seem to be triggered off by an upsetting event, such as the break-up of a relationship. Sometimes it need not even be a bad event but just an important one, like marriage or leaving home.


In anorexia it is usually family members who realise that something is wrong when they notice their sister or daughter is not only thin but continuing to lose weight. Although to others this weight loss appears alarming and excessive, the sufferer will hardly ever admit that there is a problem. She continues to believe that she is over-weight. In fact, even others may not recognise the problem for some time because of the large amounts of 'healthy' (but of course non-fattening) foods that she eats.

In bulimia the sufferer often feels guilty and ashamed of her behaviour and may go to great lengths to hide it. This is despite the fact that eating huge amounts of food and then vomiting it back up is extremely time-consuming and exhausting. It may affect her performance at work and will certainly make it difficult to lead an active social life. So, it can be a huge relief finally to have to admit to the problem. She may often he forced to do this by changing circumstances, such as a new relationship or living with other people.


The first step to treating a disorder is recognising it. It is much easier to help somebody with anorexia or bulimia if the problem is spotted and dealt with quickly The longer that it remains unrecognised, the worse the problem tends to become, and the harder it is to help. Anorexia can be life-threatening, so it is important to see a doctor, the sooner the better


Once the problem is recognised, the sufferer should be seen by a psychiatrist or psychologist who has experience with these disorders. Your family doctor will know who to contact. Although until recently there has been a tendency to admit people with anorexia to hospital, most can be treated as out-patients if the weight loss is not too severe.


The first step the psychiatrist will take is to have a long talk with the patient to find out when the problem started and how it developed. This will involve discussing many aspects of her feelings and her life. She will need to be weighed. Depending on the loss of weight, a physical examination and blood tests may be necessary. With her permission, the psychiatrist will almost certainly want to talk with her friends and family members, to see what light they may be able to shed on the problem.


If someone has become excessively thin and her periods have stopped, it makes sense for her to try to get back to somewhere near an acceptable weight. To help with this, both she and her family will first need information. What is a 'normal' weight for her? How many calories are needed each day to get there? For many sufferers, the most important question is, "How can I make sure that I don't shoot past that weight and become fat?". In anorexia, the patient has excessive control of her eating. How can she ease up? For youngsters still living at home, it is the parents' job to watch over the food that is eaten, at least for a while. This involves both making sure that she has regular meals with the rest of the family, and that she gets enough calories. Mounds of lettuce can be very deceptive. It is also important that the family see the psychiatrist regularly both to check on weight and for support, as having an anorexic in the family can be extremely stressful.

For most sufferers it will be important to discuss things that may be upsetting them - boys, school, self-consciousness, family problems, etc.

Only if these simple steps do not work, or if the weight loss threatens life, is admission to hospital usually considered. In-patient treatment consists of much the same combination of dietary control and talking, only in a much more structured environment.


Here, the priority is to get back to a regular pattern of eating. The aim is to maintain a steady weight on three meals a day at regular times, without either starving or vomiting. Sufferers are usually older than anorexics and not living at home, so the emphasis is more on their keeping diaries of their disordered eating habits and developing self-control. Again, dietary information needs to be given so the sufferer doesn't get disheartened by gaining too much weight.

The other important part of treatment is psychotherapy - talking about things in the past or the present that may have a bearing on the eating disorder and other personal difficulties.

For those sufferers with depression in addition to their bulimia, anti-depressant medication may be necessary.

Having seen your doctor or specialist, you may find it helpful to join a self-help group in which other people share similar problems. These groups can provide both information and support during the difficult times that everybody with these problems goes through. Your family doctor should be able to recommend a suitable local group.

Reading can help to give you the information you need to eat sensibly, and to know what a reasonable weight is for you.

Eating Disorders Association: 1st Floor, Wensum House, 103 Prince of Wales Road, Norwich NR1 1DW.
Helplines: 01 603 621 414 (open 9:00 to 18:30 weekdays)
Youthline: 01 603 765 050 (open 16:00 to 18:00 weekdays)
Fax: 01 603 664 915 International No: +44 1603 664 915 Email: info@edauk.com


A to Z of Anorexia Nervosa from The Eating Disorders Association (see above)

Anorexia Nervosa and Bulimia - How to Help. M Duker & R Slade, Open University Press

Anorexia Nervosa R L Palmer, Penguin Books

Anorexia Nervosa: the wish to change 2nd ed. A H Crisp and others, £9.95

Terug naar indeling achtergrondsinformatie