SelfhelpMagazine

Personalities

Most people with eating disorders share certain personality traits: low self-esteem, feelings of helplessness, and a fear of becoming fat. In anorexia, bulimia, and binge eating disorder, eating behaviors seem to develop as a way of handling stress and anxieties.

People with anorexia tend to be "too good to be true." They rarely disobey, keep their feelings to themselves, and tend to be perfectionists, good students, and excellent athletes.

Some researchers believe that people with anorexia restrict food -- particularly carbohydrates -- to gain a sense of control in some area of their lives. Having followed the wishes of others for the most part, they have not learned how to cope with the problems typical of adolescence, growing up, and becoming independent.

Controlling their weight appears to offer two advantages, at least initially: they can take control of their bodies and gain approval from others. However, it eventually becomes clear to other that they are out-of-control and dangerously thin.

People who develop bulimia and binge eating disorder typically consume huge amounts of food -- often junk food -- to reduce stress and relieve anxiety. With binge eating, however, comes guilt and depression. Purging can bring relief, but it is only temporary. Individuals with bulimia are also impulsive and more likely to engage in risky behavior such as abuse of alcohol and drugs.

Genetic and environmental factors

Eating disorders appear to run in families -- with female relatives most often affected. This finding suggests that genetic factors may predispose some people to eating disorders; however, other influences -- both behavioral and environmental -- may also play a role. One recent study found that mothers who are overly concerned about their daughters' weight and physical attractiveness may put the girls at increased risk of developing an eating disorder. In addition, girls with eating disorders often have father and brothers who are overly critical of their weight.

Although most victims of anorexia and bulimia are adolescent and young adult women, these illnesses can also strike men and older women. Anorexia and bulimia are found most often in Caucasians, but these illnesses also affect African Americans and other racial ethnic groups. People pursuing professions or activities that emphasize thinness -- like modeling, dancing, gymnastics, wrestling, and long-distance running -- are more susceptible to the problem. In contrast to other eating disorders, one-third to one-fourth of all patients with binge eating disorder are men. Preliminary studies also show that the condition occurs equally among African Americans and Caucasians.

Biochemistry

In an attempt to understand eating disorders, scientists have studied the biochemical on the neuroendocrine system -- a combination of the central nervous and hormonal systems. Through complex but carefully balanced feedback mechanisms, the neuroendocrine system regulates sexual function, physical growth and development, appetite and digestion, sleep, heart and kidney function, emotions, thinking, and memory--in other words, multiple functions of the mind and body. Many of these regulatory mechanisms are seriously disturbed in people with eating disorders.

In the central nervous system -- particularly the brain -- key chemical messengers known as neurotransmitters control hormone production. Scientists have found that the neurotransmitters serotonin and norepinephrine function abnormally in people affected by depression. Recently, researchers funded by NIMH have learned that these neurotransmitters are also decreased in acutely ill anorexia and bulimia patients and long-term recovered anorexia patients. Because many people with eating disorders also appear to suffer from depression, some scientists believe that there may be a link between these two disorders. In fact, new research has suggested that some patients with anorexia may respond well to the antidepressant medication fluoxetine which affects serotonin function in the body.

People with either anorexia or certain forms of depression also tend to have higher than normal levels of cortisol, a brain hormone released in response to stress. Scientists have been able to show that the excess levels of cortisol in both anorexia and depression are caused by a problem that occurs in or near a region of the brain called the hypothalamus.

In addition to connections between depression and eating disorders, scientists have found biochemical similarities between people with eating disorders and obsessive-compulsive disorder (OCD). Just as serotonin levels are known to be abnormal in people with depression and eating disorders, they are also abnormal in patients with OCD.

Recently, NIMH researchers have found that many patients with bulimia have obsessive-compulsive behavior as severe as that seen in patients actually diagnosed with OCD. Conversely, patients with OCD frequently have abnormal eating behaviors.

The hormone vasopressin is another brain chemical found to be abnormal in people with eating disorders and OCD. NIMH researchers have shown that levels of this hormone are elevated in patients with OCD, anorexia, and bulimia. Normally released in response to physical and possibly emotional stress, vasopressin may contribute to the obsessive behavior seen in some patients with eating disorders.

NIMH-supported investigators are also exploring the role of other brain chemicals in eating behavior. Many are conducting studies in animals to shed some light on human disorders. For example, scientists have found that levels of neuropeptide Y and peptide YY, recently shown to be elevated in patients with anorexia and bulimia, stimulate eating behavior in laboratory animals. Other investigators have found that cholecystokinin (CCK), a hormone known to be low in some women with bulimia, causes laboratory animals to feel full and stop eating. This finding may possibly explain why women with bulimia do not feel satisfied after eating and continue to binge.

Written by Lee Hoffman, Office of Scientific Information (OSI), National Institute of Mental Health (NIMH). An earlier version was prepared by OSI staff member Marilyn Sargent.

Scientific review was provided by NIMH staff Susan J. Blumenthal, M.D.; Harold Goldstein, Ph.D.; Harry E. Gwirtsman, M.D.; and Susan Z. Yanovski, M.D.

U.S. Department of Health and Human Services
Public Health Service

National Institutes of Health
National Institute of Mental Health

People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all these forms of purging. Because many individuals with bulimia "binge and purge" in secret and maintain normal or above normal body weight, they can often successfully hide their problem from others for years.

Lisa developed bulimia nervosa at 18. Like Deborah, her strange eating behavior began when she started to diet. She too dieted and exercised to lose weight, but unlike Deborah, she regularly ate huge amounts of food and maintained her normal weight by forcing herself to vomit. Lisa often felt like an emotional powder keg -- angry, frightened, and depressed.

Unable to understand her own behavior, she thought no one else would either. She felt isolated and lonely. Typically, when things were not going well, she would be overcome with an uncontrollable desire for sweets. She would eat pounds of candy and cake at a time, and often not stop until she was exhausted or in severe pain. Then, overwhelmed with guilt and disgust, she would make herself vomit.

Her eating habits so embarrassed her that she kept them secret until, depressed by her mounting problems, she attempted suicide. Fortunately, she didn't succeed. While recuperating in the hospital, she was referred to an eating disorders clinic where she became involved in group therapy. There she received medications to treat the illness and the understanding and help she so desperately needed from others who had the same problem.

Family, friends, and physicians may have difficulty detecting bulimia in someone they know. Many individuals with the disorder remain at normal body weight or above because of their frequent binges and purges, which can range from once or twice a week to several times a day. Dieting heavily between episodes of binging and purging is also common. Eventually, half of those with anorexia will develop bulimia.

As with anorexia, bulimia typically begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia, ashamed of their strange habits, do not seek help until they reach their thirties or forties. By this time, their eating behavior is deeply ingrained and more difficult to change.

Written by Lee Hoffman, Office of Scientific Information (OSI), National Institute of Mental Health (NIMH). An earlier version was prepared by OSI staff member Marilyn Sargent.

Scientific review was provided by NIMH staff Susan J. Blumenthal, M.D.; Harold Goldstein, Ph.D.; Harry E. Gwirtsman, M.D.; and Susan Z. Yanovski, M.D.

U.S. Department of Health and Human Services
Public Health Service

National Institutes of Health
National Institute of Mental Health

Each year millions of people in the United States are affected by serious and sometimes life-threatening eating disorders. The vast majority -- more than 90 percent -- of those afflicted with eating disorders are adolescent and young adult women. One reason that women in this age group are particularly vulnerable to eating disorders is their tendency to go on strict diets to achieve an "ideal" figure. Researchers have found that such stringent dieting can play a key role in triggering eating disorders.

Approximately 1 percent of adolescent girls develop anorexia nervosa, a dangerous condition in which they can literally starve themselves to death. Another 2 to 3 percent of young women develop bulimia nervosa, a destructive pattern of excessive overeating followed by vomiting or other "purging" behaviors to control their weight. These eating disorders also occur in men and older women, but much less frequently.

The consequences of eating disorders can be severe. For example, one in ten cases of anorexia nervosa leads to death from starvation, cardiac arrest, other medical complications, or suicide. Fortunately, increasing awareness of the dangers of eating disorders - -sparked by medical studies and extensive media coverage of the illness -- has led many people to seek help. Nevertheless, some people with eating disorders refuse to admit that they have a problem and do not get treatment. Family members and friends can help recognize the problem and encourage the person to seek treatment.

This NIH material provides valuable information to individuals suffering from eating disorders, as well as to family members and friends trying to help someone cope with the illness. This series of articles describes the symptoms of eating disorders, possible causes, treatment options, and how to take the first steps toward recovery.

Scientists funded by the National Institute of Mental Health (NIMH) are actively studying ways to treat and understand eating disorders. In NIMH-supported research, scientists have found that people with eating disorders who get early treatment have a better chance of full recovery than those who wait years before getting help.

Written by Lee Hoffman, Office of Scientific Information (OSI), National Institute of Mental Health (NIMH). An earlier version was prepared by OSI staff member Marilyn Sargent.

Scientific review was provided by NIMH staff Susan J. Blumenthal, M.D.; Harold Goldstein, Ph.D.; Harry E. Gwirtsman, M.D.; and Susan Z. Yanovski, M.D.

U.S. Department of Health and Human Services
Public Health Service

National Institutes of Health
National Institute of Mental Health

An illness that resembles bulimia nervosa is binge eating disorder. Like bulimia, the disorder is characterized by episodes of uncontrolled eating or binging. However, binge eating disorder differs from bulimia because its sufferers do not purge their bodies of excess food.

Individuals with binge eating disorder feel that they lose control of themselves when eating. They eat large quantities of food and do not stop until they are uncomfortably full. Usually, they have more difficulty losing weight and keeping it off than do people with other serious weight problems. Most people with the disorder are obese and have a history of weight fluctuations. Binge eating disorder is found in about 2 percent on the general population -- more often in women than men. Recent research shows that binge eating disorder occurs in about 30 percent of people participating in medically supervised weight control programs.

Written by Lee Hoffman, Office of Scientific Information (OSI), National Institute of Mental Health (NIMH). An earlier version was prepared by OSI staff member Marilyn Sargent.

Scientific review was provided by NIMH staff Susan J. Blumenthal, M.D.; Harold Goldstein, Ph.D.; Harry E. Gwirtsman, M.D.; and Susan Z. Yanovski, M.D.

U.S. Department of Health and Human Services
Public Health Service

National Institutes of Health
National Institute of Mental Health

People who intentionally starve themselves suffer from an eating disorder called anorexia nervosa. The disorder, which usually begins in young people around the time of puberty, involves extreme weight loss -- at least 15 percent below the individual's normal body weight. Many people with the disorder look emaciated but are convinced they are overweight. Sometimes they must be hospitalized to prevent starvation.

Deborah developed anorexia nervosa when she was 16. A rather shy, studious teenager, she tried hard to please everyone. She had an attractive appearance, but was slightly overweight. Like many teenager girls, she was interested in boys but concerned that she wasn't pretty enough to get their attention. When her father jokingly remarked that she would never get a date if she didn't take off some weight, she took him seriously and began to diet relentlessly -- never believing she was thin enough even when she became extremely underweight.

Soon after the pounds started dropping off, Deborah's menstrual periods stopped. As anorexia tightened its grip, she became obsessed with dieting and food and developed strange eating rituals. Every day she weighed all the food she would eat on a kitchen scale, cutting solids into minuscule pieces and precisely measuring liquids. She would then put her daily ration in small containers, lining them up in neat rows. She also exercised compulsively, even after she weakened and became faint. She never took an elevator if she could walk up steps.

No one was able to convince Deborah that she was in danger. Finally, her doctor insisted that she be hospitalized and carefully monitored for treatment of her illness. While in the hospital, she secretly continued her exercise regimen in the bathroom, doing strenuous routines of sit-ups and knee-bends. It took several hospitalizations and a good deal of individual and family outpatient therapy for Deborah to face and solve her problems.

Deborah's case is not unusual. People with anorexia typically starve themselves, even though they suffer terribly from hunger pains. One of the most frightening aspects of the disorder is that people with anorexia continue to think they are overweight even when they are bone-thin. For reasons not yet understood, they become terrified of gaining any weight.

Food and weight become obsessions. For some, the compulsiveness shows up in strange eating rituals or the refusal to eat in front of others. It is not uncommon for people with anorexia to collect recipes and prepare gourmet feasts for family and friends, but not partake in the meals themselves. Like Deborah, they may adhere to strict exercise routines to keep off weight. Loss of monthly menstrual periods is typical in women with the disorder. Men with anorexia often become impotent.

Written by Lee Hoffman, Office of Scientific Information (OSI), National Institute of Mental Health (NIMH). An earlier version was prepared by OSI staff member Marilyn Sargent.

Scientific review was provided by NIMH staff Susan J. Blumenthal, M.D.; Harold Goldstein, Ph.D.; Harry E. Gwirtsman, M.D.; and Susan Z. Yanovski, M.D.

U.S. Department of Health and Human Services
Public Health Service

National Institutes of Health
National Institute of Mental Health

NIH Publication No. 94-3477 Printed 1993