“I am forever engaged in a silent battle in my head over whether or not to lift the fork to my mouth, and when I talk myself into taking the bite, I taste only shame,” writes Jena Morrow in her memoir, Hollow: An Unpolished Tale (Moody Publishers, 2010). In her book Morrow recounts the pain and suffering she endured as she struggled to overcome the eating disorder anorexia nervosa.
Morrow's silent battle echoes those of the 0.6 percent of the U.S. population who will develop anorexia at some point in their life. Another 1 percent will experience bulimia nervosa, according to a 2007 survey by psychiatrist James I. Hudson of Harvard Medical School and his associates. Although these figures are lower than for most other psychological conditions, eating disorders can be emotionally and physically devastating.
Sufferers of both anorexia and bulimia are preoccupied with their weight and the shape of their body, and their self-esteem is based largely on how satisfied they are with these two physical characteristics. Individuals with anorexia often refuse to eat, lose significant amounts of weight and are consumed by a fear of becoming overweight. Sufferers also have the distorted belief that they are overweight when, in fact, they are not.
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Bulimia is characterized by frequent binges during which an unusually large amount of food is consumed. People with bulimia fear that they will gain weight from their binges, and so they try to avoid putting on pounds, usually by forcing themselves to vomit or taking large amounts of laxatives and diuretics.
Proper understanding of these disorders is critical for knowing who is at risk and getting them proper treatment. Yet many people hold serious misconceptions about anorexia and bulimia. Here are five of them:
Myth #1: Eating disorders are extremely rare in men and boys.
Fact: Although eating disorders are more common among females than males, a significant percentage of males struggle with them. Hudson and his associates found that 0.9 percent of females and 0.3 percent of males had or currently have anorexia. The corresponding figures for bulimia were 1.5 and 0.5 percent.
Myth #2: Anorexia is the only life-threatening eating disorder.
Fact: Eating disorders have the highest mortality of any mental illness because of medical complications and suicide. In a 2009 paper, psychiatrist Scott Crow of the University of Minnesota Medical School and his colleagues analyzed the death records of 1,885 people who were evaluated eight to 25 years previously at an eating disorders clinic at Minnesota. The mortality rates for anorexia and bulimia in this group were about the same: approximately 4 percent. Other investigators have found somewhat higher mortality for anorexia than for bulimia, but bulimia can be deadly, too.
Myth #3: Purging is an effective way to lose weight.
Fact: Most people with bulimia very likely believe in this myth, or they would not vomit or use medications in an attempt to eliminate calories. Although purging is one of the formal criteria for bulimia, many people with anorexia purge as well. Yet purging is not effective for weight loss. Laxatives and diuretics cause water loss, which is soon replaced. Laxatives get rid of only 10 percent of the calories eaten. Vomiting is also relatively ineffective. By the time a person has induced vomiting, typically immediately after the binge has ended, the body has absorbed 50 to 75 percent of the ingested food. Not only is purging ineffective for weight loss, but it can cause serious dehydration, electrolyte imbalances and other problems, all of which may lead to serious illness or death.
Myth #4: Body weight is one clue that a person has bulimia.
Fact: Despite bingeing, individuals with bulimia have body weights that are indistinguishable on average from those who do not have the disorder. Perhaps the most obvious sign of bulimia is puffy cheeks because of the enlargement of the salivary glands from purging. Still, friends and family are often unaware that bulimia causes this physical sign. Because the disorder can be difficult to spot, those who suffer from it often fail to get the support they need to seek treatment.
In contrast, an excessively thin appearance may be a clue that a person has anorexia. In the later stages, when an individual is 20 to 30 percent or more underweight, the disorder becomes even more obvious.
Myth #5: Recovery from eating disorders is rare.
Fact: Many studies support the efficacy of a type of cognitive-behavior therapy (CBT) for bulimia in which therapists educate patients about bulimia—for example, they explain why purging is ineffective—alter dysfunctional thoughts about weight, and teach strategies for resisting the impulse to binge and purge. In a report published in 2000 psychiatrist W. Stewart Agras of the Stanford University School of Medicine and his colleagues gave 220 individuals diagnosed with bulimia either 19 sessions of CBT or of interpersonal therapy (IPT), which focuses on the interpersonal context of the problem and resolving conflicts that may contribute to the disorder. When treatment ended, 29 percent of those who received CBT had recovered, compared with only 6 percent of those who underwent IPT. One year later, however, the success rates were more comparable; 40 percent of the CBT recipients and 27 percent of those given IPT no longer had the disorder. Although there is considerable room for improvement, these findings suggest that certain types of therapy can be very helpful for bulimia.
The picture is less encouraging for anorexia. The first goal is to restore body weight to normal or near normal, something that is often achieved in a hospital. Surprisingly, 85 percent of hospitalized patients gain enough weight to go home, where the challenge is to keep them at a healthy weight. Some data suggest that CBT similar to that used for bulimia can prevent relapse of anorexia. In 2003 psychologist Kathleen M. Pike of Columbia University and her colleagues assigned 33 patients with anorexia who had been released from a hospital to a year of either CBT or nutritional counseling. At the end of treatment, only 22 percent of the CBT group had relapsed or dropped out compared with 73 percent of the group that received nutritional counseling. What is more, 44 percent of the CBT patients showed significant improvement and 17 percent full recovery compared with 7 and 0 percent, respectively, in the nutritional-counseling group. Although the results for CBT are promising, we are not close to a cure for anorexia, especially given that other researchers who have followed patients for longer have found much higher relapse rates.
Still, some individuals with anorexia do recover. And the more people who know the facts about eating disorders such as anorexia and bulimia, the sooner these serious illnesses will be recognized and treated.
