What's happening here? For over fifty percent of our female population, the good life has become the pursuit of thinness. Because, of course, thinness typifies control, discipline, beauty, success and popularity. Thin is in and so is perfection. Never before have women had the range of possibilities they have today. Sexual biases and economic barriers are vastly reduced, making anything possible for women.

In this decade more than at any other period in our history, women can achieve their definition of the ideal self. Our expectations are at an all time high; much too high in the ten to thirty percent of women who develop bulimia or anorexia. These are the eating disorders of overachievers. Women who are striving to do it all (perfectly) and be it all (perfect).

Anything less than their ideal self is failure. Highly critical of themselves (including their bodies) and fearing they won't achieve their ideals, they become anxious, guilty, and depressed. For these women, excessive food or the lack of food becomes a means of coping with feelings of fear, inadequacy, dependency, depression and failure.

Bulimia Nervosa

The eating disorder termed bulimia is characterized by binge-eating, or continually consuming large amounts of high caloric foods until one feels gorged or bloated. Thirty percent of college women and ten percent of college men engage in binge-eating. In some of our colleges, binge-eating or pig outs have become a group practice much like keggers. For ten percent of the population engaging in this activity, it becomes an addictive cycle and progresses into the chronic illness called bulimia.

Others may develop this illness as a complication of restrictive dieting. In an effort to lose weight, one may severely restrict one's caloric intake for a period of time until he or she is overcome by the desire to eat sweets or favorite foods. Then, one pizza or one chocolate bar is not enough and bingeing results.

Ten to twenty percent of binge-eaters will resort to self-induced vomiting to relieve their sense of bloating or fullness and the fear of weight gain resulting from a binge. Other forms of purging may also be used to alleviate the effects of binge-eating such as laxative abuse, diuretics, heavy periods of sleep or starving. For women, (and a small percentage of men), experiencing life in a society where thin is highly prized and in which success includes being measured by the size of your jeans, weight control becomes life control. As binge-eating becomes habitual, the cycle regenerates itself and compulsive bingeing sets in. Purging (i.e., vomiting, laxative abuse, etc.) becomes a coping mechanism to alleviate the physical distress of gorging and the psychological guilt and fear of being out of control. Each binge sets off more negative feelings and each purge adds to the load of unresolved feelings and stressors. It is in every respect a vicious self-perpetuating cycle.

On the surface, the desire to be thin may appear to be the cause of this disorder, but food is not the real issue. The real issues are the underlying fears, doubts, insecurities and low self-esteem of women who are perfectionists and high achievers. They are sensitive, intelligent individuals who despite outward appearances, feel helpless and out of control with their lives.

For these women, bulimia becomes a means of controlling their bodies and eating habits, and of gaining some power over their lives. But instead of gaining control, bulimia takes control. Because the true underlying feelings are not being confronted, this eating disorder leads to serious depression, withdrawal, guilt, a pervasive sense of hopelessness, despair and serious physical complications.

CASE STUDY

Lisa developed bulimia nervosa at 18. Her strange eating behavior began when she started to diet and exercise in an effort to lose weight. 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 bingeing 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.

Medical Complications

Bulimia nervosa patients--even those of normal weight--can severely damage their bodies by frequent binge eating and purging. In rare instances, binge eating causes the stomach to rupture; purging may result in heart failure due to loss of vital minerals, such as potassium. Vomiting causes other less deadly, but serious, problems--the acid in vomit wears down the outer layer of the teeth and can cause scarring on the backs of hands when fingers are pushed down the throat to induce vomiting. Further, the esophagus becomes inflamed and glands near the cheeks become swollen. As in anorexia, bulimia may lead to irregular menstrual periods. Interest in sex may also diminish.

Some individuals with bulimia struggle with addictions, including abuse of drugs and alcohol and compulsive stealing. Like individuals with anorexia, many people with bulimia suffer from clinical depression, anxiety, obsessive compulsive disorder, and other psychiatric illnesses. These problems, combined with their impulsive tendencies, place them at increased risk for suicidal behavior.

Treatment

Eating disorders are most successfully treated when diagnosed early. Unfortunately, even when family members confront the ill person about his or her behavior, or physicians make a diagnosis, individuals with eating disorders may deny that they have a problem. People with bulimia are often normal weight and are able to hide their illness from others for years. Eating disorders in males may be overlooked because anorexia and bulimia are relatively rare in boys and men. Consequently, getting--and keeping--people with these disorders into treatment can be extremely difficult.

In any case, it cannot be overemphasized how important treatment is--the sooner, the better. The longer abnormal eating behaviors persist, the more difficult it is to overcome the disorder and its effects on the body. In some cases, long-term treatment may be required. Families and friends offering support and encouragement can play an important role in the success of the treatment program.

If an eating disorder is suspected, particularly if it involves weight loss, the first step is a complete physical examination to rule out any other illnesses. Once an eating disorder is diagnosed, the clinician must determine whether the patient is in immediate medical danger and requires inpatient treatment.

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.