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

FDA Consumer, May, 1986 by Dixie Farley

Some studies have found these characteristics of families of anorectics: poor communicating skills, conflict avoidance, over-concern with appearances, overemphasis on high achievement, and overinvolvement with one another. But UCLA's Yager found that the significance of many of the researchers' observations could not be properly evaluated. "If common personality patterns are to be found in these families," he wrote, "they will have to be at more subtle levels."

While there are differences of opinion about treatment for anorexia and bulimia, the one point on which all agree is that early treatment is important to recovery. In fact, it is essential because, as either disorder becomes more and more entrenched, damage to the body becomes less and less reversible.

How then to treat these disorders?

According to Bruch, "A realistic body-image concept is a precondition for recovery in anorexia nervosa." Considering the anorectic's tenacious denial of being too thin or eating too little, convincing her that she needs to gain weight is no small task. A prime example of resistance is this defense by one of Bruch's patients, "Of course I had breakfast; I ate my Cheerio." In contrast, bulimics usually cooperate with the medical staff; they may even seek treatment voluntarily.

Several approaches are usually used to treat both disorders, including motivating the patient, enlisting family support, and providing nutrition counseling and psychotherapy. Behavior modification therapy and drug therapy may be used as well.

Hospitalization may be required for patients who have life-threatening complications or extreme psychological problems. If the patient's life is not in danger, treatment for either disorder is usually on an outpatient basis. Treatment may take a year or more. However, in their book, New Hope for Binge Eaters, Drs. Harrison Pope Jr. and James Hudson reported that more than 80 percent of their patients with bulimia responded to antidepressant drug therapy within three to four weeks. For anorectics, however, they write that the benefits of antidepressants "must be regarded as tentative" and that precautions should be taken to determine whether the patient's undernourished body can handle the drugs.

Psychotherapy may be in many forms. In individual sessions, the patient explores attitudes about weight, food and body image. Then, as she becomes aware of her problems in relating to others and dealing with stress, her attention is centered on feelings she may have about self-esteem, guilt, anxiety, depression or helplessness. Constructive, nonjudgmental feedback is given to encourage growth and independence. In behavior modification therapy, the focus is on eliminating self-defeating behaviors. Patients may improve their stress management by learning skills in relaxation, biofeedback and assertiveness. Family therapy is designed to improve overall family functioning. Group psychotherapy may help reduce a sense of isolation and secrecy and is especially effective for bulimics.