Eating disorders; when thinness becomes an obsession - includes related article on tips for parents

FDA Consumer, May, 1986 by Dixie Farley

Eating Disorders When Thinness Becomes An Obsession

Hula hoops, the bunny hop, punk hair styles. Fads come and go, and most are harmless. But when it's a fad to self-induce symptoms of a severe illness, the current craze isn't harmless anymore.

That hazardous fad involves bulimia, a severe eating disorder of compulsive bingeing and purging. People with bulimia rapidly eat tremendous amounts of food and then get rid of the food by vomiting or other means. Bulimia symptoms are found in 40 percent to 50 percent of patients with another potentially life-threatening disorder called anorexia nervosa, or compulsive self-starvation.

"Bulimia almost has celebrity status, the 'in' thing to have," says Dr. Sue Bailey, director of the Eating Disorders Clinic at the Washington (D.C.) Hospital Center. According to Bailey, victims think at first that they've found a great solution to weight control, that "they can eat whatever they want and get rid of it. Then, after a couple of years, it hits: 'I thought I could stop any time. But I can't.'"

Bailey was medical consultant to a recent Gallup Poll which projected that about 2 million American women 19 to 39 and 1 million teen-agers are affected by some symptoms of bulimia or anorexia. In her own survey of several Washington, D.C., area private schools, Bailey found that 28 percent of one school's eighth graders said they would consider vomiting to lose weight. Many reported dieting since age 13, being dissatisfied with their body since age 10, and always trying to be perfect. "In other words," she says, " many girls were showing a real vulnerability to an eating disorder."

U.S. studies of female high school and college students suggest a bulimia prevalence ranging from 4.5 percent to 18 percent. But in the American Journal of Psychiatry (July 1985), Kathleen Hart and Dr. Thomas Ollendick of Virginia Polytechnic Institute and State University reviewed many studies and found that "when more stringent criteria are used with college samples, the prevalence of the syndrome of bulimia is markedly less than that suggested by the prevalence of the symptom of binge eating." Their own study put the occurrence of bulimia syndrome in female college students at 5 percent. Anorexia is estimated to occur in one of every 200 females aged 12 to 18. Males are said to account for about 5 percent to 10 percent of bulimia and anorexia cases. (Because male victims are few, we'll refer to all patients as females.) More research is needed to determine the exact incidence of bulimia and anorexia.

People of all races can develop bulimia and anorexia, but the vast majority of patients are white, which may reflect socio-economic, rather than racial, factors. Yet the illnesses are not restricted to females with certain occupational or educational backgrounds. What causes the illnesses and why they occur primarily in females are unknown.

The disorders are obsessive--that is, most victims can't stop their self-destructive behavior without professional medical help. Left untreated, either disorder can become chronic and can result in severe health damage, even death. While the number of deaths from bulimia are unknown, 101 deaths from anorexia were reported in 1983, the latest year fo which statistics are available. Fortunately, early diagnosis with prompt treatment greatly improves the chances of recovery from these disorders.

The American Psychiatric Association's criteria for diagnosing bulimia and anorexia are currently being revised. All criteria must be met for a case to be recognized as an occurrence of bulimia or anorexia. The working draft of the revisions reads as follows.

For the syndrome of bulimia:

* Recurrent episodes of binge-eating (rapid consumption of a large amount of food in a discrete period of time, usually less than two hours).

* During the eating binges there is a feeling of lack of control over the eating behavior.

* The individual regularly engages in either self-induced vomiting, use of laxatives, or rigorous dieting or fasting in order to counteract the effects of the binge-eating.

* A minimum average of two binge-eating episodes per week for at least three months.

For the syndrome of anorexia nervosa:

* Intense fear of becoming obese, even when underweight.

* Disturbance in the way in which one's body weight, size or shape is experienced--e.g., claiming to "feel fat" even when emaciated, belief that one area of the body is "too fat" even when obviously underweight.

* Refusal to maintain body weight over a minimal normal weight for age and height--e.g., weight loss leading to maintenance of body weight 15 percent below expected; failure to make expected weight gain during period of growth, leading to body weight 15 percent below expected.

* In females, absence of at least three consecutive menstrual cycles when otherwise expected to occur (primary or secondary amenorrhea). [Primary amenorrhea means menstruation fails to occur at puberty; secondary amenorrhea means menstruation ceases after having been established.]