Overcoming Eating Disorders
By Carol Sorgen
Reviewed By Michael Smith
Chances are you know someone -- probably a teen-age girl or young woman -- who suffers from anorexia or bulimia. Though the perception is that eating disorders are nearly impossible to treat, experts say that close to 90% of the time, people can overcome them.
Unfortunately, says Edward J. Cumella, PhD, eating disorders are all too common. One out of 10 women will suffer from an eating disorder at some point in her life; for adolescents, that number is one out of 5, says Cumella, research director at Remuda Treatment Centers in Wickenburg, Ariz., a 101-bed inpatient facility devoted exclusively to the treatment of anorexia and bulimia in adolescent girls and women.
Bulimia is five times more common than anorexia, says Cumella, because "most people are not able to starve themselves."
The reasons for such a high prevalence rate are two-fold, says Cumella. First, there's the biological component. "Some people are born with a predisposition to having an eating disorder," he says, explaining that there are genetic markers that can push a person in the direction of anorexia or bulimia.
Eating disorders run in families, Cumella adds. "If you see a young girl or young woman with an eating disorder, there is a 12 times greater chance that her sibling, or one of her parents, has -- or has had in the past -- an eating disorder as well."
Having that genetic predisposition, however, does not guarantee that a person will automatically suffer from an eating disorder. "The environment -- a person's life experience -- still has to pull the trigger," says Cumella.
"We live in a toxic environment when it comes to eating disorders," says Cumella. "The message we receive, especially on TV, is that being super-thin is important."
To emphasize his point, Cumella says that on the Island of Fiji, there was little television before 1995 ... and eating disorders were rarely, if ever, heard of. In fact, "plump" was considered the ideal body shape for girls and women. In the five years following the widespread introduction of TV, eating disorders skyrocketed, says Cumella.
Though eating disorders strike girls and women more often, boys and men are not immune, says Denise Lensky, PhD, director of the Eating Disorders Program at Belmont Center for Comprehensive Treatment, part of Albert Einstein Healthcare Network in Philadelphia. "Media images for men are getting more pernicious as well," says Lensky, although she adds that males are more likely to end up with eating disorders because of pressures related to keeping their weight down for certain sports (such as wrestling and swimming) than because of concerns about their appearance.
The messages that bombard us about thinness sometimes make treating an eating disorder difficult, says Cumella. An hour of outpatient therapy a week can help a person with anorexia or bulimia deal with issues of self-esteem and self-acceptance, but then, it's back to the TV, the movies, the fashion magazines. "You can't be isolated from the world," says Cumella. "An hour a week is difficult to counteract the messages being received from all the other sources. They just undo the therapy."
That said, outpatient therapy can be effective if the eating disorder is treated in its early stages. Counseling, combined with consultations with a nutritionist, can work quickly, says Cumella.
If left untreated, or if treatment isn't successful, eating disorders can result in serious physical problems, says Cumella, including low blood sugar, pancreas and liver damage, heart failure, osteoporosis, heart rhythm problems, and thought impairment.
That is why it's so important to seek help early, says Salvatore Cullari, PhD, chair of the psychology department at Lebanon Valley College in Annville, Penn., and specialist in treating people afflicted by eating disorders.
"It's important to get help, because eating disorders lead to death in 15% of cases," says Cullari. If you suspect that a friend or family member has an eating disorder, you need to talk to that person, says Cullari, not in a confrontational manner, but in a supportive, informative fashion. "People need to know the facts about anorexia," says Cullari. "They often don't know that this is a life-threatening, serious disorder, but that it can be treated."
If you have already tried this, and the person continues to lose weight, hospitalization is probably in order, says Cullari. "At some point, action needs to be taken."
An inpatient treatment program consists of a multi-pronged approach, says Cumella. The first step is re-feeding. "If the brain is starved, it can't process any information, and there is also a change in personality ... a person becomes perfectionistic, compulsive, and rigid." After a couple of weeks of healthy nutrition, "the personality comes back," says Cumella.
Along with the re-feeding process comes cognitive behavioral therapy, to change the woman's way of thinking about herself and about her relation to food; and family therapy (there are frequently family issues involved in eating disorders), says Cumella. Sometimes an eating disorder is the woman's only way of saying, "I'm here."
Though the average inpatient stay at Remuda is 54 days (45 for bulimics, 60 for anorexics), the good news is that the success rate is about 90%, says Cumella.
There has always been a perception of high failure rates when it comes to treating eating disorders, but that's not really the case, says Lensky. "Eating disorders can be as successfully treated as any other compulsive behavioral disorder," she says. "People who suffer from eating disorders feel hopeless and ashamed, which may keep them from seeking help. But when they do, eating disorders are treatable."
Reviewed by Michael W. Smith, MD, June 11, 2002.
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