Most of us have attempted to diet at one time or another. But how do you know when you have crossed the line and put yourself at risk of an eating disorder? Today, eating disorders are the leading cause of death among mental illnesses, and people who suffer from them are at great psychological and physical risk.

New research presented this week at the Academy for Eating Disorders meeting shows that there may be additional risks for people who are overly concerned with their weight. Researchers report that kids who are very self-conscious about how much they weigh are also more likely to smoke and get drunk than those who are not. In another study researchers found that women with anorexia nervosa are 50 times more likely to commit suicide than women in the general population.

Due to this association with increased dangerous and even deadly behavior, it is important to know if you or someone you love may have an eating disorder. The easiest way to determine this is to examine whether you or the person in question has become uncontrollably preoccupied with food, weight loss, and body image.

Are You at Risk for an Eating Disorder?

• Do you obsess about food and feel ashamed about your present body size or weight?
• Do you vomit or take diet pills or laxatives for an extended period of time or in excess of directed use?
• Do you starve yourself?
• Do you feel guilty or punish yourself after you eat?
• Do you start a new diet every morning?
• Do you exercise too much?
• Do you spend increasingly more time in the bathroom?
• Do you avoid discussing food?
• Do you weigh yourself daily or more than once a day?
• Do you feel depressed and isolated?
• Do you avoid social activities or mandatory functions such as school or work in order to maintain your daily regimen of diet and exercise?
• Do you experience frequent mood swings?
• If you are a woman, have you had interruptions in your menstrual cycle or an absence of your period?

Types of Eating Disorders

Anorexia nervosa
Anorexia nervosa is characterized as a disorder in which people refuse to maintain a minimally normal weight, have an intense fear of gaining weight, and often misinterpret their body shape. It is not uncommon for a woman suffering from anorexia to weigh only 15 percent of her normal body weight and still think she looks fat. Individuals who are plagued by anorexia are usually persistent in their pursuit for thinness. They often possess perfectionist characteristics and are rather high functioning. Their pursuit to thinness often leads to starvation, which can lead to death.

Anorexia is an eating disorder that is more typical in women than in men, and can come about at any age. But studies show that the onset typically happens in adolescence. However, in my practice, I have seen girls as young as age nine diagnosed with anorexia.

Signs of anorexia:

• Refusal to maintain normal body weight for age and height
• Intense fear of becoming fat
• Weight loss due to any of the following: severe fasting and/or abuse of diuretics, laxatives, amphetamines, exercise, and vomiting
• Ritualistic behavior about food, such as cutting food into baby-sized pieces
• Difficulty eating in public
• Secretive behavior

• Depression
• Frequent mood swings
• Obsession about weight loss
• Isolation from friends and family
• Avoidance of sexual relationships

• Frequent headaches
• Osteoporosis
• Amenorrhea (loss of period)
• Dark circles under the eyes
• Grayish skin
• Brittle hair and hair loss
• Erosion of tooth enamel
• Dental problems
• Heart failure

Bulimia is more common than anorexia, but is often harder to detect. People with bulimia often maintain their ideal body weight and therefore the disease can go unnoticed. The onset of this disorder often occurs later in adolescence than anorexia, and can be diagnosed in early adulthood.

Signs of bulimia include:

• Ideal weight is often maintained
• Intense fear of becoming fat
• Lack of control around food
• Preoccupation with thoughts of food, eating, or not eating
• Eating until feeling uncomfortably full
• Experiences hunger often
• Secretive eating, going to extreme measures to obtain food such as going through garbage or stealing

• Frequent mood swings
• Depression
• Lack of impulse control
• Drug and alcohol abuse
• Self mutilation
• Low self esteem
• Strong desire to be liked and accepted
• Increase in sexual activity
• Thoughts of suicide

• Loss of tooth enamel
• Dental problems
• Thyroid problems
• Sore throat
• Menstrual cycle may be abnormal or absent
• Heart problems or heart failure

The good news is that if you, or someone you know, is suffering from an eating disorder, there is help available. Like all illnesses, the sooner you seek treatment, the faster your recovery will be and the fewer complications you will experience. Eating disorders are addictive, progressive, and potentially fatal, and the changes they can cause in your body are not always immediately visable. Each person is unique, and their battle with an eating disorder requires an individualized plan to meet their specific needs. A physician should always be consulted and a routine physical exam should be conducted to detect any health-related problems.

Inpatient treatment
Hospitalization or treatment at a residential facility that specializes in eating disorders may be necessary, especially if there are immediate health concerns. This type of treatment uses a team approach, integrating individual therapy, group therapy with other patients, family counseling, and medical and nutritional care.

Outpatient treatment
Outpatient treatment is similar to inpatient treatment, except that the patient does not stay in the hospital overnight. An individual receives a specific plan based on her (or his) needs. There may be support groups as well as educational programs, lectures, or seminars on specific topics to help the patient cope with surviving everyday normal life.

Psychotherapy
Counseling can be extremely useful in treatment of both anorexia and bulimia. Building a trusting relationship with a therapist can help an individual suffering from an eating disorder understand why they are having difficulty around food, weight, and body image, and help them adapt their behavior to return to normalcy.

Group therapy
Group meeting with others who are experiencing the difficulties of an eating disorder can provide mutual support and understanding. Group therapy can help in breaking unhealthy eating patterns and identifying emotional issues that trigger symptoms.

Family therapy
Eating disorders not only affect the individual who is suffering from the disease, but can also disrupt the entire family. Counseling can help the family gain a better understanding of the disease and therefore provide better support.

Self help
There are numerous books and tapes available at bookstores or your local library that discuss many of the issues surrounding the complexity of eating disorders. Also, there are self-help groups and 12-step programs similar to Alcoholics Anonymous; most communities have Overeaters Anonymous, often referred to as OA, which is listed in local yellow pages.

Summary

If left untreated, eating disorders such as anorexia and bulimia can have devastating consequences, both psychologically and physically. However, if an individual seeks treatment, eating disorders can be managed and a full recovery can be expected. The key is to get help.

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