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A Body to Die For: The ABC's of Eating Disorders

Kathryn J. Zerbe, M.D.
 
Dr. Zerbe is the Jack Aron Professor of Psychiatric Education and Women's Mental Health and Director of the Eating Disorders Program at the Menninger Clinic, Topeka, Kansas. She is the author of the landmark book for patients and families,"The Body Betrayed: Women, Eating Disorders, and Treatment."

I had gone to a lot of trouble to land myself in the hospital. At 15, I had embarked on a diet and had shed 50 pounds in six months. My body had started out slightly padded, clad in baggy painter's pants to conceal my thighs. As I shrank, I wore tighter pants to flaunt my success, until those too began to hang on my diminishing frame.


- from Evelyn Strauss's, "Facing the Plate" (Salon 9/13/00), a personal account of the author's experience with an eating disorder.


This is a horrifying but typical picture of a young woman suffering from an eating disorder — something that, according to the National Institute of Mental Health, affects more than five million Americans today.(1) Aside from cases where depression or other mental illness leads to suicide, it is hard to think of a psychological problem that poses a greater threat to a person's physical health. Those afflicted with eating disorders try to lose weight by dieting, purging or other means until they make themselves sick. Though some get treatment and recover, others literally starve themselves to death.

As Ms. Strauss's story illustrates, a particularly troublesome aspect of this illness is that while its victims may appear not to understand that they are making themselves sick, most of the time they know exactly what they are doing to their bodies. In cases like these, friends and family members can beg, plead and try all they want to convince victims that they are too thin or that they are ruining their health but they continue to do it anyway.

What can you do if you or someone you care about is suffering from an eating disorder? The good news is that there are treatments. The first step, however, is to become informed about what eating disorders are, the different kinds and how they affect the body.

There are two main types of eating disorders. Their technical names are anorexia nervosa and bulimia nervosa. The table below shows the main ways in which they differ.

Eating disorders are a uniquely dangerous form of mental illness.

Table 1.
Eating Disorders

(Based on the American Psychiatric Association's Diagnostic and Statistic Manual, IV)
Anorexia Nervosa
  1. Refusal to maintain body weight at or above a minimally normal weight for age
  2. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight
  3. In postmenarcheal females, amenorrhea, i.e., for at least three consecutive menstrual cycles.
Restricting Type:
person not regularly engaged in binge-eating or purging behaviors
Binge-Eating/Purging Type:
In addition to symptoms of anorexia nervosa, the person regularly engages in binge-eating or purging behaviors.
Bulimia Nervosa
  1. Recurrent episodes of binge eating characterized by 1) eating in a discrete amount of time a large amount of food and 2) a sense of lack of control over eating during the episode
  2. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, and other medications; fasting or excessive exercise
  3. The binge-eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for three months
  4. Self-evaluation is unduly influenced by body shape and weight
  5. The disturbance does not occur exclusively during episodes of anorexia nervosa.
Purging Type:
During episodes of bulimia nervosa, the person regularly engages in self-induced vomiting, misuse of laxatives, diuretics, or enemas.

Nonpurging Type:
During the episodes of bulimia nervosa, the person has used other inappropriate compensatory behavior such as fasting or excessive exercise but has not regularly engaged in the purgative methods listed above.
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(1) Comment has been made

Sara
The re-feeding process was really hard for me. I was trying to overcome this disease with too much enthusiasm and suffered Edema among a list of other complications. I only weighed 62 pounds and I am 5'6. Horrible, I know. I almost died, on a couple of occasions actually, but always came back for whatever reason. Anyway, this is a horrible disease and very hard to overcome, especially alone. I do not believe that I will ever be over this, unfortunaltly, but I am physically healthy now. I have a healthy 4 year old daughter to live for and I hope she never suffers through life with anything as I have been suffering with Anorexia since I was 12. I have to live for me, to live for her.
Posted Mon, Apr. 5, 2010 at 2:26 am EDT



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