Anorexia and bulimia: causes and treatment
Anorexia and bulimia are serious mental health disorders that develop from excessive concern about body weight and shape. They are more than just strict dieting or a passing whim — they are conditions that require professional help and understanding.
What causes anorexia and bulimia?
Over recent decades, eating disorders have become the most common mental health problem among young women. They are significantly less common in men. These disorders usually begin in adolescence, most often at ages 14–18.
Anorexia is particularly common among people whose profession or hobby requires them to be thin: models, ballerinas, figure skaters and gymnasts. This is no coincidence — your environment shapes your attitude towards your body from an early age.
Many young people with eating disorders have grown up in achievement-oriented families with high expectations. They are capable, hardworking and well-behaved — and hide their negative feelings. Perfectionism and a degree of rigidity are often apparent even before the disorder develops. People with bulimia, however, tend to be more outwardly expressive, showing anger and impulsivity more openly.
A lack of security in childhood, sexual abuse and other factors that contribute to the development of psychiatric disorders are more common in the histories of people with eating disorders than in those of healthy people. Twin studies also suggest a genetic predisposition.
Culture also plays a part. The media frequently repeat the message that a slim woman is successful, happy and loved. Approximately 80% of healthy young women say they are unhappy with their weight, and many actively try to control it.
About 50% of people with anorexia also experience episodes of binge eating — a symptom characteristic of bulimia. These two diagnoses are not mutually exclusive: many people with bulimia have previously had anorexia.
Symptoms of anorexia and bulimia
The main feature of anorexia is maintaining a body weight at least 15% below the minimum normal weight for your age and height. This is accompanied by an intense fear of gaining weight and a distorted body image — you feel fat even when you are dangerously underweight.
Thoughts become increasingly focused on food. Mood becomes unstable, irritability and low mood develop, and social life narrows. In women, the absence of at least 3 consecutive menstrual periods is characteristic. Persuasion, rewards and threats do not help — even if you promise to stop starving yourself.
Bulimia involves episodes of binge eating: consuming a large amount of food in a short time. This is followed by guilt and compensatory behaviors — self-induced vomiting, laxative use, strict dieting or excessive exercise. Binge eating is usually followed by low mood and self-disparagement. People with bulimia are usually within the normal weight range, so the disorder often goes unnoticed.
Treatment options and prognosis
The goals of anorexia treatment are to overcome malnutrition, normalize eating behavior and prepare you to return to everyday life. People who are seriously ill and deny their condition often need hospital treatment. Hospital treatment is usually unnecessary for bulimia because people with the condition are more motivated to engage in treatment.
Cognitive behavioral therapy is the most effective treatment for both disorders. It is based on the understanding that extreme dietary restriction leads to binge eating, which in turn reinforces the symptoms of the disorder. Well-conducted studies show that a cognitive behavioral treatment program eliminates bulimia symptoms in 70–80% of people, with improvements lasting over the long term in about half of those treated.
Family therapy is also well suited to younger patients. Medication mainly helps when anorexia is accompanied by depression. Antidepressants are beneficial for bulimia, but they are less effective than psychotherapy.
Follow-up studies lasting 5–10 years show that approximately half of people who receive appropriate treatment for bulimia remain permanently free of symptoms. In 30%, the disorder continues intermittently, and in 20%, it persists continuously. Alcohol and medication misuse lead to a poor prognosis. It is important to know that recovery has occurred even after 12 years of severe illness. You must never lose hope.
FAQ
Can anorexia affect men too?
Yes, although eating disorders are much less common in men than in women. The disorder usually begins in adolescence and can affect anyone, regardless of gender.
What is the difference between anorexia and bulimia?
With anorexia, you are underweight and refuse to eat. With bulimia, episodes of binge eating alternate with compensatory behaviors, and your weight is usually within the normal range. Both disorders can occur at the same time.
Where should I seek help if I suspect an eating disorder?
Your first step is to see your family doctor, who will refer you to a psychiatrist or psychotherapist. Early treatment significantly improves the prognosis — seeking help is a sign of strength, not weakness.
Author: Marek Morozov
Source: WHO – physical activity.
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