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% - of those afflicted with eating disorders are female adolescents and young adult women.

Eating is controlled by many factors, including appetite, food availability, family, peer, and cultural practices, and attempts at voluntary control. Dieting to a body weight leaner than needed for health is highly promoted by current fashion trends, sales campaigns for special foods, and in some activities and professions.

Eating disorders involve serious disturbances in eating behavior, such as extreme and unhealthy reduction of food intake or severe overeating, as well as feelings of distress about body shape or weight.

Eating disorders are not due to a failure of will or behavior; rather, they are real, treatable medical illnesses in which certain maladaptive patterns of eating take on a life of their own. The main types of eating disorders are anorexia nervosa and bulimia nervosa. A third type, binge eating disorder, has been suggested but has not yet been approved as a formal psychiatric diagnosis. Eating disorders frequently develop during adolescence or early adulthood, but some reports indicate their onset can occur during childhood or later in adulthood.

Anorexia Nervosa

An estimated 0.5 to 3.7 percent of females suffer from anorexia nervosa in their lifetime. Symptoms of anorexia nervosa include:

• Resistance to maintaining body weight at or above a minimally normal weight for age and height.
• Intense fear of gaining weight or becoming fat, even though underweight.
• 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.

People with this disorder see themselves as overweight even though they are dangerously thin. The process of eating becomes an obsession. Unusual eating habits develop, such as avoiding food and meals, picking out a few foods and eating these in small quantities, or carefully weighing and portioning food. People with anorexia may repeatedly check their body weight, and many engage in other techniques to control their weight, such as intense and compulsive exercise, purging by means of vomiting, and abuse of laxatives, enemas, and diuretics.

The course and outcome of anorexia nervosa vary among individuals: some fully recover after a single episode, some have a fluctuating pattern of weight gain and relapse and others experience a chronically deteriorating course of illness over many years. The mortality rate among people with anorexia has been estimated at 0.56 percent per year, which is about 12 times higher than the annual death rate due to all causes of death among females ages 15-24 in the general population. The most common causes of death are complications of the disorder, such as cardiac arrest, electrolyte imbalance, and suicide.

Bulimia Nervosa

An estimated 1.1 percent to 4.2 percent of females have bulimia nervosa in their lifetime. Symptoms of bulimia nervosa include:

• Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode.
• Recurrent, inappropriate compensatory behavior in order to prevent weight gain, such as self- induced vomiting or misuse of laxatives, diuretics, enemas, or other medications (purging), fasting, or excessive exercise.
• The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
• Self-evaluation is unduly influenced by body shape and weight.

Because purging or other compensatory behavior follows the binge eating episodes, people with bulimia usually weigh within the normal range for their age and height. However, like individuals with anorexia, they may fear gaining weight, desire to lose weight, and feel intensely dissatisfied with their bodies. People with bulimia often perform the behaviors in secrecy, feeling disgusted and ashamed when they binge, yet relieved once they purge.

Binge Eating

Community surveys have estimated that between 2 percent and 5 percent of Americans experience binge eating disorder in a 6-month period. Symptoms of binge eating disorder include:

Recurrent episodes of binge eating, characterized by eating an excessive amount of food within a discrete period of time and by a sense of lack of control over eating during the episode

The binge eating episodes are associated with at least 3 of the following: eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of being embarrassed by how much one is eating, feeling disgusted with oneself, depressed, or very guilty after overeating

People with binge eating disorder experience frequent episodes of out-of-control eating, with the same binge eating symptoms as those with bulimia. The main difference is that individuals with binge eating disorder do not purge their bodies of excess calories. Therefore, many with the disorder are overweight for their age and height. Feelings of self-disgust and shame associated with this illness can lead to bingeing again, creating a cycle of binge eating.

The Path to Healing

Treatment can save the life of someone with an eating disorder. The sooner these disorders are diagnosed and treated, the better the outcomes are likely to be. Because of their complexity, eating disorders require a comprehensive treatment plan involving medical care and monitoring, psychosocial interventions, nutritional counseling and, when appropriate, medication management.

Treatment of anorexia calls for a specific program that involves three main phases: (1) restoring weight lost by severe dieting and purging, (2) treating psychological disturbances such as distortion of body image, low self-esteem, and interpersonal conflicts, and (3) achieving long-term remission and rehabilitation, or full recovery.

Early diagnosis and treatment increase the treatment success rate. Use of psychotropic medication in people with anorexia should be considered only after weight gain has been established. The acute management of severe weight loss is usually provided in a residential setting, such as Rimrock's, where feeding plans address the person's medical and nutritional needs. Once malnutrition has been corrected and weight gain has begun, psychotherapy can help people with anorexia overcome low self-esteem and address distorted thought and behavior patterns.

The primary goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. To this end, nutritional rehabilitation, psychosocial intervention, and medication management strategies are often employed. Establishment of a pattern of regular, non-binge meals, improvement of attitudes related to the eating disorder, encouragement of healthy but not excessive exercise, and resolution of co-occurring conditions such as mood or anxiety disorders are among the specific aims of these strategies.

Psychotropic medications, primarily antidepressants, have been found helpful for people with bulimia, particularly those with significant symptoms of depression or anxiety or those who have not responded adequately to psychosocial treatment alone. These medications also may help prevent relapse.

People with eating disorders often do not recognize or admit that they are ill. As a result, they may strongly resist getting and staying in treatment. Family members or other trusted individuals can be helpful in ensuring that the person with an eating disorder receives needed care and rehabilitation. For some people, treatment may be long term.

Rimrock Foundation has four licensed Crisis Stabilization beds available for patients who may need a short-term stay for the purpose of stabilizing them on prescribed medications or who may need a safe place with medical monitoring and evaluation but who do not require the full services of an acute psychiatric facility. These beds serve as an alternative to hospitalization and may be accessed by referral from the patient's physician, case manager or therapist. Call our Crisis Program Coordinator for more information or to make a referral.

For further information about our effective eating disorder treatment programs, call Althea Bartlett, Admissions Supervisor at 1-800-227-3953 or 1-406-248-3175. For more educational information on eating disorders, contact the Library at 1-800-227-3953 or 1-406-248-3175.