- How long have eating
disorders been around? What is their history?
There are descriptions of disorders very
like what we now call anorexia nervosa and bulimia nervosa in
ancient Egyptian hieroglyphics and Persian manuscripts. Scrolls
originating in early Chinese dynasties also mention behaviors
similar to the starving and stuffing of today’s eating disorders.
Ancient Romans overindulged at lavish banquets and then relieved
themselves in a vomitorium (lavatory chamber that accommodated
vomiting) so they could return to the feast and continue eating.
African tribal lore contains stories of
individuals who refused to eat during times of famine so their
children might have the little bit of food that was available.
They were much admired by peers who could not exercise the same
rigid self-denial. When the famine passed, a few of the voluntary
restrictors continued to refuse to eat and were in danger of
dying. Some were healed by shamans who induced trance states
similar to what we now know as hypnotherapy.
In Europe, the first formal description
of anorexia nervosa in medical literature was made by Richard
Morton in London in 1689. He is credited with first describing
an anorexic patient as “a skeleton clad only with skin.”
Two other physicians, Lasegue in 1873 in France and Gull in 1874
in England, wrote the first two articles about anorexia nervosa
in modern medical literature.
At first anorexia nervosa was thought to
be a form of tuberculosis or a manifestation of some other physical
disease or disorder, perhaps related to hormone imbalance or
endocrine deficiency. It was not until the 1930s that researchers
began to believe that the causes of self-starvation were psychological
and emotional. Today clinicians believe that eating disorders
represent the final outcome when emotional distress interacts
with physiological imbalance (including the imbalances caused
by dieting) in a vulnerable individual. Effective treatment,
of course, will address both physical and psychological factors.
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- What’s the most effective
treatment for someone with an eating disorder who is also abusing
alcohol and other drugs?
In most cases, effective treatment means
tackling the substance abuse first. When people are clean and
sober, they don’t use substances. Period. That same kind of abstinence
is not possible with food, so in some ways recovery from substance
abuse is easier than recovery from an eating disorder where the
person must face the trigger substance (food) three or four times
After nine to twelve months of sobriety,
most people have become stable enough to move on to treatment
of the eating disorder. If they are truly committed to sobriety,
they won’t switch coping behaviors back to alcohol and other
drugs when the going gets rough. If, however, they begin by working
on the eating disorder, without a commitment to sobriety, they
almost always escalate substance abuse as they decrease disordered
Of course if the person is in medical danger
because of the eating disorder, some intervention should be made
early on to preserve life. A physician and treatment team must
make this judgment call. Many substance abuse treatment centers
have an eating disorders track for their dual-diagnosis patients.
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- Why don’t you have
more on this site about support groups?
We are ambivalent about eating disorders
support groups. For someone who has recently begun to starve
or stuff, especially someone young in years, we recommend formal
treatment to quickly break disordered eating patterns and restore
physical and psychological health. If people find friends and
acceptance in a support group, they may begin to define their
identity as “eating disordered” so they can continue
to belong and participate. That makes recovery much harder.
On the other hand, we know that not everyone
will get into treatment, and of those who do, not everyone will
make progress and recover in a timely manner. For these more
chronic sufferers, a support group can provide valuable encouragement
and a safe place to problem solve and talk about challenges.
We are especially concerned about informal
groups led by parents or people who themselves are still recovering
from an eating disorder. In our experience, the most effective
groups are led or supervised by a professional mental health
therapist as part of an integrated treatment program. Without
the involvement of an experienced professional, groups tend to
deteriorate into subtle competitions to see who can be the thinnest
and who can produce the most alarming story. Without supervision,
the group’s focus tends to shift from developing more effective
behaviors to caretaking and noncritical acceptance of even the
most irresponsible choices and decisions.
Also, if a lay leader is not confirmed
in his or her own recovery, there will be temptation to relapse
when group dynamics become intense and the focus remains on food
and weight behaviors instead of on problem solving.
For these reasons we are cautious advocates
of support groups. While many people have found much help in
well-run groups, in too many cases unsupervised support groups
have led to problems and even crises when no experienced professional
was present to defuse problems before they escalated.
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- I’m anorexic, not
bulimic. Why are my teeth decaying at the gum line?
People who have anorexia often have saliva
deficient in the buffers that protect teeth from the effects
of acid manufactured by bacteria in the mouth. There is also
significant acid in many of the low-cal foods and soft drinks
that anorexics favor.
Normal saliva contains buffers that protect
teeth from acid. The body makes those buffers in part from materials
found in fatty foods. If you don’t eat enough dietary fat, your
body can’t protect your teeth adequately. Tell your dentist what’s
going on. There are steps you can take to prevent or minimize
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- How do I calculate
my ideal weight? How much body fat is healthy?
We don’t like the term “ideal”
weight; it’s too dependent on unrealistic images foisted on us
by the media. Your healthy body weight is that weight
at which you are strong, energetic, and healthy. Everybody’s
body is different. Don’t rely on charts, tables, or complex formulas
involving body measurements to determine what’s healthy for you.
Instead, eat a balanced, moderate, and varied diet that includes
lots of fruits, vegetables, and whole grains. Low-fat or non-fat
dairy products contribute to healthy bones. Go easy on high-fat
and high-sugar foods, but allow yourself to enjoy moderate amounts
to satisfy your body’s need for the nutrients they provide and
so you don’t feel deprived and vulnerable to bingeing.
Regular, moderate exercise helps stabilize
weight, and it also gives you a whole host of long- and short-term
You are at a healthy weight when you have
enough strength and energy to lead a healthy, normal life. You
know you are on the right track when your blood pressure, cholesterol,
and blood sugar levels are normal, and when you have no back
or joint pain because of undernutrition (loss of minerals from
bones) or extra weight. If you are a woman, the presence of normal
menstrual periods is an indicator of health.
If you are female, and if you want additional
reassurance, ask your doctor to arrange a pelvic ultrasound.
This procedure reflects nutritional status during the previous
two months and indicates the reproductive status of your uterus
and ovaries. This kind of ultrasound gives a picture of reproductive
maturity, which can be halted and even reversed by dieting and
And that pesky body fat issue: The most
commonly accepted figures for healthy levels are 18 to 23 percent
for adult men and 18 to 28 percent for adult women. Anything
less than that may produce significant physiological problems
such as loss of bone minerals leading to osteoporosis and hormone
deficiencies that contribute to loss of libido, sexual difficulties,
and impaired fertility.
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- I read in a book
that bingeing can permanently distend one’s stomach. Is this
For some people, bingeing does indeed stretch
and distend the abdomen, making it look poochy. Eating a large
meal and then falling asleep, when all the muscles have relaxed,
can have the same effect. Some folks tighten up when they stop
bingeing, others do not in spite of crunches and other exercises.
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- I am trying to eat,
but when I do, I feel bloated for hours. It’s not body image
distortion, but a real, physical feeling of being too full. Help!
One of the common consequences of an eating
disorder is slowed gastric motility. That means that food stays
in your stomach and intestines longer than it did before you
began to diet. Your GI tract does not pass digesting food along
as rapidly as it did before. Of course you then feel stuffed.
If you persist in eating normal amounts
of normal foods, your body should gradually return to normal.
In the beginning it may help to limit really greasy foods and
other items that are harder to digest. As you progress in recovery,
you can add back reasonable portions of these foods so your body
can learn to handle them once again. In addition, small frequent
meals may be easier for your body to handle than three large
In cases like this, it’s always a good
idea to check with a physician to rule out the possibility of
a medical problem. Serious problems are rare, but they do happen.
If loss of gastric motility is causing undue distress, your doctor
can prescribe medications for temporary use that will speed up
the digestive process. These meds, however, should not be used
indefinitely. The goal is to achieve normal digestion without
artificial aids. Best wishes, and congratulations on all you
have accomplished so far.
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- Do I need to fast
periodically to detoxify my body?
No. This is a subject that has grown an
extensive mythology, but none of it is based on scientific fact.
Your body is very efficient in cleansing itself, including the
digestive tract. There is no evidence to suggest that you get
“toxic” by eating normally. Nor do your stomach and
intestines need to rest every once in a while. In fact, fasting
can be dangerous for people with eating disorders. It can cause
headaches, fatigue, nausea, crankiness, drops in blood pressure,
and irregular heart beat. It is especially dangerous for people
with diabetes, liver disease, or impaired kidneys. Pregnant women
should never fast. We do not recommend this hazardous and ineffective
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- Are there different
degrees of eating disorders?
Yes. Because of unrealistic cultural demands
for thinness, probably most of us are more concerned about body
shape and size than a totally healthy person would be. It’s a
long way, however, from an occasional, brief diet and fleeting
dissatisfaction about body shape and size to the rigid preoccupations
and ever-present obsessions about food and weight manifested
by people who have clinical eating disorders.
There are also differences in mental, physical,
and emotional impairment between someone who has just begun an
eating disorder and someone else who has starved or stuffed for
many years. Likewise, there are differences between people whose
symptoms are less severe and those who are in crisis.
The problem with all of this is that, without
treatment, eating disorders tend to get worse, not better. It
is not unusual for someone to begin an eating disorder with seemingly
minor behaviors that quickly progress to threaten life and happiness.
If you are concerned about yourself or your minor child, arrange
for medical and psychological evaluations right away. If you
are concerned about a friend, urge her/him to seek professional
advice before the problem becomes intractable.
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- I used to have an
eating disorder, and now I want to help other people. What can
First you must decide if you want to make
helping people a career or a volunteer activity. If you want
a career, prepare yourself by getting at least a masters degree
in psychology, counseling, psychiatric nursing, or clinical social
work. If you want more training, you could become a psychiatrist
or a clinical psychologist. The people in your campus academic
counseling center can help you arrange the classes you need for
these options. Be aware that you will need to meet licensing
requirements in most states in the U.S.
If you want to do volunteer work, we recommend
you get involved with NEDA – National
Eating Disorders Association. They have several programs
across the United States. Visit their web site for details on
how you can combat eating disorders in your own community.
Wanting to help others is admirable, but
make sure your recovery is solid before you begin. Focusing on
disordered eating behaviors and the painful underlying issues
may undermine your own progress unless your are comfortable with
your body, enjoying a wide variety of normal foods, and aware
of and on top of the issues that brought you to starving or stuffing
in the first place. You must decide if it would be wisest for
you to move on or if you are indeed strong enough to help others.
See the letter from a licensed professional
counselor on our Forum page for more thoughts on this issue.
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- How can I be certified
as an eating disorders specialist?
There is no course of study that leads
to a degree in eating disorders. Because anorexia nervosa, bulimia,
and binge eating disorder are multidimensional problems (multiple
causes, complex dynamics, paradoxical motivations, interlinked
triggers, self-reinforcing maintainers, and the like), a clinician
is well advised to obtain a general degree and subsequent license
in medicine (psychiatry, pediatrics, gastroenterology, etc.),
psychology, counseling, or clinical social work. After that basic
preparation, additional work, both theoretical and clinical,
can lead to specialization in the field of eating disorders.
At present there is only one organization
that offers certification in this field, and that certificate
may or may not be recognized by state licensing bodies and insurance
companies. For information,contact the International
Association of Eating Disorders Professionals.
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- I’m too skinny.
How can I gain weight?
You have to eat more calories each day
than you burn up in basic metabolic functions and activity. Here
are a few suggestions: eat larger portions than usual; eat five
or six times a day rather than the usual three. Don’t ever skip
meals. Choose high calorie snacks in addition to healthy whole
grains, fruits, and vegetables. Keep snacks small in size but
calorically dense so they don’t fill you up and spoil your appetite
for the next meal.
Example: peanut butter and nuts on half
a whole wheat bagel. Spread olive oil on bread or use it as a
dipping sauce. Use real mayonnaise made with vegetable oil on
salads and sandwiches instead of the reduced-fat varieties.
Snack between meals, but don’t spoil your
appetite. A couple of extra sandwiches on whole-grain bread each
day in addition to your regular meals should lead to weight gain.
The trick is to eat healthy foods. Ice
cream, sauces, gravies, and fatty meats will give you calories,
but their fats are saturated and therefore not very healthy.
Focus on foods that contain olive or canola oil or other monosaturated
or polyunsaturated vegetable oils. All are beneficial to health
when used as part of a balanced meal plan.
Drink a couple of cans of liquid supplement
in between meals. Avoid the weight-loss stuff (like Slim-Fast)
and stick with true supplements like Susta-Cal and Ensure. Ask
your pharmacist for a recommendation, including a recommendation
for taste. Some of these food substitutes taste like cardboard,
but they are nutritionally complete and balanced.
Reduce your aerobic exercise for a while
and switch to weight lifting which promotes muscle development.
Muscle weighs more than fat. Remember that you will tend to gain
weight as you grow older and, if you are female, after childbirth
and menopause. You may always be slender, but you will be rounder
If you feel anxious when you think about
weight gain, wear loose clothing as your body changes. Tight
jeans, waistbands, or belts may trigger panic, and you don’t
need that. Also, if you find that the new weight seems to be
concentrated in the middle part of your body, be patient. Once
your weight stabilizes at its new level, you can design an exercise
program to redistribute it and develop new muscle all over your
Be aware that every human body, in the words of one visitor to
the ANRED web site, “has its own metabolic destiny, regardless
of what fashion dictates.” If Mother Nature designed you
to be slim, gaining weight for you may be as difficult or impossible
as losing it is for someone who is naturally round and plump.
If a physical exam shows that you are healthy, you will be smart
to check with a counselor who can help you resist society’s insistence
that you be someone you are not.
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- My child wants to
be a vegetarian, and I’m concerned. Something is not right. Could
she be developing an eating disorder?
In most cases, vegetarianism is a healthy
way to eat. In fact, adult vegetarians tend to live longer, are
generally leaner, and are less likely to be diagnosed with heart
disease and some cancers than adults who consume animal products.
(source: authors of study summarized below)
There may be a problem, however, when adolscents
decide to give up meat and other animal-based foods. A study
at the University of Minnesota found that teen vegetarians were
more weight- and body-conscious, more likely to have been told
by a doctor that they had an eating disorder, and more likely
to have tried a variety of healthy and unhealthy weight control
practices including diet pills, laxatives and vomiting. They
were also more likely than their peers to have contemplated or
The study also found that male vegetarians
were even more likely to engage in unhealthy weight control practices,
such as vomiting after eating and weighing themselves frequently,
than were non-vegetarian males.
The findings suggest that vegetarianism
may serve as a red flag for eating and other problems related
to self-image in teens, concludes Dr. Cheryl L. Perry and colleagues
who ran the study.
Semi-vegetarians, those who ate some animal
products, were more likely to engage in weight-control practices.
Semi-vegetarians, the authors suggest, may be using vegetarianism
as another form of weight control.
The study appeared in J Adolesc Health
2001;29:406-416 and was reported by Reuters Health, December
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