Mental health conditions
Although 'anorexia' means loss of appetite, this is quite misleading. Someone with anorexia will deny themselves food, although they may actually feel extremely hungry. It's also very inaccurate to call it the 'slimmer's disease', and dangerous if it means dismissing the problem. It takes no account of what's behind such an extreme response; negative feelings, such as low self-worth, extreme fear of rejection and a distorted self-image.
How would I know if someone was anorexic?
There are a number of signs that someone with anorexia may show:
- losing a great deal of weight
- denying they feel hungry
- taking drastic measures to avoid putting on weight, such as: avoiding foods high in calories; making themselves sick; exercising excessively; using drugs that quell the appetite or speed up digestion; counting calories meticulously, and wearing baggy clothing to cover up any weight loss, or to keep warm
- weighing much less than they should (at least 15 per cent less than the expected weight for their age and height)
- believing that they look fat, although they are considered underweight
- being physically underdeveloped (this may happen if the problem occurs before puberty)
- missing three, or more, menstrual periods in a row (although this may not occur if they are taking a contraceptive pill)
- losing interest in sex or become impotent
- hiding food, or throwing it away
- changes in their personality.
People can get a 'high' from denying themselves food or exercising too much. But, as they eat less and less, they will feel weaker, perhaps depressed and more and more tired.
Anorexia can affect every aspect of life; thinking, concentration and the ability to move around. It may be life threatening.
Bulimia means eating large amounts of food, and then trying to undo the effects by starving themselves, or by vomiting or, less usually, by using laxatives (both known as purging). In extreme cases, someone can be making themselves sick as often as 30 to 40 times a day.
Bulimia is more common than anorexia, but because people keep their weight roughly the same, it's not so visible.
People are often at great pains to keep the bulimia outwardly hidden. Inwardly, they will be thinking constantly about eating, and having irresistible cravings for particular foods. They dread being fat and believe they should be much thinner than a normal weight.
Contrary to what people believe, taking laxatives doesn't actually help with weight loss, but removes essential minerals, such as potassium and sodium, which keep the muscles working. Being sick gets rid of less than half the calories consumed, according to one study, and diuretic drugs, which rid the body of fluid, have no effect on the calories absorbed. A flat stomach may be a temporary benefit, but it soon returns to normal when fluid levels rise again.
Media attention has glamorised, and so trivialised, bulimia nervosa. But the effects are not trivial. They include having poor skin, because of being dehydrated, bad teeth caused by stomach acids eroding the tooth enamel, bad breath, a sore throat and mouth ulcers. Periods may also become irregular or stop altogether. Frequent vomiting can cause epileptic fits, muscular weakness and heart problems, while taking a lot of laxatives can also cause permanent damage.
Someone who eats compulsively has come to rely on food for emotional support. They may pick at food all day, and feel they can't stop themselves. As a result, they are likely to be heavily overweight, and in danger of developing health problems because of it.
Compulsive eating is a way of masking problems, often connected with close relationships. Underneath it, people may feel very worthless, lonely and empty, and have a deep sense of loss. Compulsive eaters often deal with problems in life by denying there's anything wrong.
When people eat very large quantities of (often) high-calorie food, all in one go, it's known as binge eating. The binges are often triggered by some serious upset, and may take place in secret. During these binges, someone may feel quite out of control. If the person is bulimic, they may follow up these episodes by making themselves sick or purging with laxatives. Others, inevitably, put on a lot of weight. Excessive binge eating may be life threatening.
The Eating Disorders Association has estimated that at least one million people in the UK are affected. The numbers involved have increased alarmingly over recent years. It can develop in boys, girls, men and women, regardless of background. As many as one woman in 20 will have some form of eating distress, the overwhelming majority of them aged 14 to 25 years old.
One in a hundred women in the UK, between the ages of 15 and 30, experience anorexia. Girls as young as five are reported to be weight-conscious, and thinking about dieting. It's possible for people to experience both anorexia and bulimia in the course of their lives. Bulimia tends to be more common among older women than anorexia, affecting one or two in every hundred, in the UK.
Compulsive eating seems to be a problem for both men and women, equally, at all ages. According to statistics, men are ten times less likely to develop anorexia than women, and rarely report bulimia. But, there is some feeling that the statistics don't reflect the true picture, because men are less likely to seek help than women. People who experience eating distress may also have other self-harming behaviour.
There is never one single cause for eating distress, but rather a patchwork of different causes, which may be to do with personality, past experiences, and current events or pressures. It's vital not to make rigid assumptions about why someone might have an eating problem. (See What can friends and relatives do?)
Stressful experiences – often, the beginning of eating distress is linked to a stressful event or trauma. This can mean physical, mental or sexual abuse, the death of someone very close, or serious family problems, such as parents getting divorced. Or it could be particular pressures at school or work, such as exams or bullying.
Developing eating problems often coincides with life changes, such as puberty, going to a new school, concerns over being gay or lesbian, or leaving home for the first time. To other family members, looking in from the outside, the eating distress may appear to come out of the blue.
Health problems – being under constant pressure from ongoing physical or mental health problems can provoke eating distress.
Personality – some people may be more vulnerable than others to eating distress. It's sometimes called a 'self-esteem disorder', because an abiding lack of self-esteem is one of the few common factors. Other important causes may be a sense of insecurity, stemming from childhood, and a longing to be safe and in control. People with eating distress, especially with anorexia, are often perfectionists, who are extremely self-critical and highly competitive. They often come from families where there's a strong focus on food and diet. It's been suggested that people might even inherit a gene that makes eating distress more likely.
Conforming to the ideal – it seems to be more and more acceptable for dieting or exercising to dominate people's lives. Images of perfect people are constantly being presented on TV and in magazines. Women are expected to be thin and men muscular. From a very early age, children are bombarded with these images, even in their toys. They may strive to achieve what they think is an ideal shape, believing this is a route to happiness and popularity.
Spiritual quest – fasting is an important ritual in many religions. Sometimes, people give spiritual reasons for their anorexia. They may feel that their bodily needs and desires are impure. They may want to disassociate themselves, as much as possible, from their physical side, while trying to be more in touch with their spirituality.
Family problems – when someone is experiencing eating distress, there are often family problems in the background. Sometimes it's the case that a child or youngster is being neglected (although not necessarily deliberately). They may have a father or mother who is ill. They may be acting as a go-between between warring parents, or providing one or other of them with emotional support. But living with someone who has an eating problem can be extremely painful and hard to cope with. It puts a great deal of pressure on the family as a whole. Any difficulties within the family could partly result from this, and will certainly be aggravated. It's important not to underestimate this.