Today we are going to talk about eating disorders and you might think, “‘But I have nothing to do with it, I don’t suffer from that”. If you do not have this problem, take the opportunity to learn about it and help someone who does. Not much is being said about eating disorders.
There are three main types: anorexia nervosa, bulimia nervosa and compulsive eating, also known as binge eating. It is estimated that 70 million people in the world suffer from eating disorders. These disorders occur 20 times more often in women than in men, and are rare in men. Anorexia nervosa usually begins in adolescence or young adulthood, while bulimia seems to start a little later. The higher socioeconomic classes, as well as professions such as mannequins and dancers, represent the individuals most at risk of these afflictions.
Scientists estimate that over the course of their lives, between 0.5% and 4% of women will suffer from anorexia nervosa, 1% to 4.2% from bulimia nervosa and 2.5% from binge eating disorder. In anorexia nervosa, 50% of patients make a complete recovery, 30% have a reasonable evolution with periods of improvement and relapse. The mortality rate can vary from 6% to 15%. Of those who die from anorexia, 54% die from physical complications of the illness, 27% from suicide and 19% from unknown causes.
But what is anorexia nervosa anyway? It’s a mental illness characterized by a person’s refusal to maintain a minimum body weight. They have a relentless pursuit of thinness, an intense fear of losing or gaining weight, altered perception of body image, denial about being thin and having problems. They don’t accept help from anyone and insist on feeling fat, even though they are underweight. Girls with anorexia nervosa also experience an interruption of menstruation for at least three months.
The person with anorexia nervosa anxiously tries to please others, but believes that no one will like them because of the character defects they feel they have. They tell lies about the amount of food they eat. The anorexic moves towards severe and dangerous self-induced weight loss. To do this, she fasts for long periods, exercises excessively and gets angry if anyone tells her she’s overdoing it. They use laxatives, diuretics, appetite suppressants and induce vomiting to force their body to lose weight.
And what is bulimia nervosa? Bulimia is characterized by a feeling of loss of self control in eating. The person has repeated episodes of binge eating a large amount of food, of any kind, for a short period of time, causing guilt, shame and fear of gaining weight. This leads to inappropriate compensatory behaviors, such as inducing vomiting several times a day, uncontrolled use of laxatives, diuretics, appetite suppressants and other medications. They also fast or exercise excessively. Some bulimics eat, vomit, use laxatives, diuretics, enemas and others fast and exercise excessively.
The third type of eating disorder is compulsive eating, also called binge eating disorder. It is an eating disorder characterized by recurrent episodes of compulsive eating, in which the person eats quickly until they are overly full, consuming large quantities of food, even though they are not hungry. They usually eat alone because they are ashamed of the amount of food they eat. The person feels guilty, depressed and ashamed after eating a large amount of food. They usually feel uncomfortable with their compulsive eating and struggle with it.
The first sign that distinguishes anorexia nervosa from bulimia nervosa is body weight. Around 70% of people with bulimia tend to be of normal weight, and 15% are moderately overweight, so they don’t suffer from the absence of food. The central point in eating disorders is not food itself, but deep emotional pain. What determines these disorders is the state of mind.
Young people with anorexia, when they look in the mirror, don’t see themselves as thin and perceive themselves as fat, even though they are dangerously underweight, i.e. they have an altered body image. At the root of this is a significant lack of self-esteem, self-disgust and panic about getting fat. This can start with a simple diet that the person decides to go on, turning into an obsession that takes over their life; when losing weight becomes an obsession and a compulsion. Just to remind you, obsession is the thought that won’t leave your head, compulsion is the act of doing, the uncontrolled attitude. Thinking too much is obsession, and doing something without control is compulsion. Compulsion is a quest to avoid emotional pain, which can be sadness, anguish, a feeling of lovelessness, fear of rejection and other sensations.
People with eating disorders generally suffer from perfectionism and an obsessive-compulsive personality structure. They worry too much about how others see them. Although they may be intelligent people with a successful career, they see themselves as inadequate and worthless. The obsession around food may be a way for the individual to try to exert some control, as they generally feel they have no control over their personal life.
Some people with anorexia nervosa feel powerful when they step on the scale and see that they’ve lost another pound, even though they’re already very thin. It’s as if they’re saying: “You see, I have something in my life that I can control, I know how to control my life.” In her family, people are usually rigid, controlling, demanding, super methodical, where the person with the eating disorder is judged by what they can do and not by what they are. This family model seems to have everything planned, everything controlled, to the detriment of personal freedom. As a result, the only thing the individual feels they can control is their mouth. It is through this that the anorexic or bulimic person believes they can gain some control and make decisions for themselves.
The psychiatrist will assess whether the problem the person has is really an eating disorder and whether it occurs at the same time, which we call comorbidity. Comorbidity, in medicine, means one illness together with another. In the case of eating disorders, 30% of people also have obsessive-compulsive disorder. Between 12% and 18% of those with anorexia nervosa and between 30% and 70% of those with bulimia have substance abuse, such as alcohol, marijuana and other drugs. Depression occurs in 80% of cases, and personality disorders affect between 20% and 97% of people with eating disorders.
Culture and the media unfortunately contribute to these disorders. Studies carried out in Fiji in 1995 revealed that the ideal female body was chubby and round. After 38 months of an American sitcom, as well as other TV shows, there was a change in the ideal female body model in that Fijian society, with many cases of teenage girls with serious eating disorders. A study by Health magazine showed that 32% of American women who appear on TV are underweight, compared to only 5% of the female population in the United States. In addition, only 3% of women who appear on TV are obese, compared to 25% of regular US women.
When we try to understand what happens in the emotional world of people who develop eating disorders, by trying to understand the psychological meaning of these sufferings, we usually find that, for some of these people, the eating disorder has become a way of unconsciously trying to succeed in life. When difficulties or seemingly unsolvable problems arise, by focusing their thoughts on food and eating or not eating, they block out painful feelings. This is because they believe and feel that they are incapable of dealing with painful feelings in an adapted, functional, normal, balanced way.
In some people, the eating disorder represents an escape process, in other words, a way of avoiding the consequences and everything that goes into growing from an adolescent into a mature adult. For the person, at first, anorexia, bulimia or binge eating seems to be the solution to all their problems; in other words, a way of controlling events. But what ends up happening is that the eating disorder acquires control over all aspects of the person’s life. This is because the eating disorder is a dysfunctional, unhealthy way for the person to deal with their conflicts, but it is what they have achieved so far.
We can understand why she is ambivalent about treatment. Being ambivalent means wanting and not wanting, liking and disliking, accepting and rejecting. These people generally become ambivalent about eating disorder treatment because, on the one hand, the illness is their way of dealing with the pains of life, it’s a defense, and on the other hand, they want to get better, but they fear the consequences of abandoning the disorder.
At the Psychiatry Institute of the Hospital das Clínicas of the USP Medical School, at the University of São Paulo, they provide a treatment service for people suffering from eating disorders. According to the team, there is no single cause responsible for these health problems. It is believed that there are multiple factors, involving biological, genetic, psychological, socio-cultural and family components. Some factors trigger eating disorders, such as important life changes like adolescence, moving away from home, graduation, starting university, starting a new job, death, divorce, marriage, family problems, among others.
However, these disorders don’t necessarily start with something dramatic. Some people are predisposed and more vulnerable to becoming ill, and a simple comment from someone about their body image can lead them to take it seriously and start obsessing about it. Triggering factors catch up with the fragile person who feels unable to cope well with the situation.
Treatment for anorexia nervosa, bulimia nervosa or binge eating needs to be done with the person’s agreement. The obstacles we encounter have to do with denial of the illness, excessive fear of becoming fat and losing control, fear of abandoning the disorder that they feel is part of their identity. Professional counseling is needed, where the psychologist will help the sufferer deal with their emotions and gain control of their body and their life again.
In therapy, the person will learn to focus their thoughts away from food and their body weight and onto their feelings, so that they can deal with them in a healthy way. Because these feelings, buried, repressed, poorly elaborated, unexpressed, not experienced or partially experienced and then thrown into the unconscious, are the psychological basis of this type of mental suffering.
Very important in the treatment of eating disorders is family counseling, because this allows each member of the family to understand the problem and establish a better relationship between each other and, of course, with the person suffering from the disorder. Hospitalization is indicated if body weight is 40% or more below normal or weight loss of around 33 pounds (15 kg) or more within 3 months. If you know somebody with this disorder, try to help. Tell them that they have a serious problem. They will deny it, because these are diseases of denial and secrecy, but gently, firmly and persistently insist that they recognize the illness and accept treatment. They won’t admit it easily.
Avoid talking about their bad eating habits and instead, talk about how they might be feeling unhappy and the possible causes of this. Focus the conversation on how things can be changed. Explain that the obsession with food, exercise and body weight doesn’t need to continue, and that it’s a real problem. A person with anorexia or bulimia is unlikely to overcome the illness on their own, without help. They need outside help. Recovery involves admitting the illness, asking for help, being willing to be vulnerable and opening up to people who can help.
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Dr. Cesar Vasconcellos de Souza is working as a psychiatrist and international speaker. He is author of 3 books, columnist of the health magazine “Vida e Saúde” for 25 years, and has a regular program on the “Novo Tempo” TV channel.