#7

Bulimia nervosa is an eating disorder characterized by restraining of food intake for a period of time followed by an over intake or binging period that results in feelings of guilt and low self-esteem. The median age of onset is 18. Sufferers attempt to overcome these feelings in a number of ways. The most common form is defensive vomiting, sometimes called purging; fasting, the use of laxatives, enemas, diuretics, and over exercising are also common. Bulimia nervosa is nine times more likely to occur in women than men (Barker 2003). Antidepressants, especially SSRIs are widely used in the treatment of bulimia nervosa. (Newell and Gournay 2000).

#6

As I entered the Colony Ballroom last Thursday night, I was filled with hope. There I saw hundreds of students gathered to hear a lecture of the mass media's negative affect on women's body image and eating disorders. As I waited for the lecture to begin, I thought about how much progress has been made in raising the level of awareness of eating disorders in recent years. I felt comforted to think of the support that would be given to those who suffer from eating disorders on our campus from the men and women who demonstrated sensitivity enough to participate in this event.

Dr. Michael Levine discussed our culture's portrayal of the thin ideal illustrated by ultra-thin supermodels and advertising that equates thinness and fitness with success. Dr. Levine suggested that this female ideal of thinness in our culture was a violence against women. This violent undermining of our rights and abilities by reducing us to thin, waif-like figures was nothing to ignore. Dr. Levine illustrated the last acceptable prejudice left in our society: that of an overt prejudice against body fat. He urged the men in the audience to discuss with women their feelings about the body, etc. He also urged the women present to be more accepting of their own bodies and more aware of their prejudice against body fat. I am aware that perhaps the greatest threat to women's negative feelings about their bodies may come from other women. At a point during the lecture, two women had some type of disagreement about a seating arrangement. Apparently the dispute remain unresolved, and one of the women moved from her row. As she stood up, the women with whom she had the dispute said 'see ya fatty.' I was absolutely shocked, so shocked in fact that five minutes passed before I heard a word of the lecture. How can we hope to battle a prejudice against body fat if women attack one another in such a way? The natural attack against another woman's body illustrates to me where our beginning point is if we hope to provide support to the women of our campus who suffer from eating disorders, as well as prevent the continued hatred toward our own bodies.

ANATOMY OF AN EATING DISORDER

My eating disorder has lived with me for more than a decade, and I have been bulimic for almost as long. I have been uncomfortable with my body for as long as I can remember. I was 'plump' as a small child. When I no longer wanted to be considered plump, I began to diet. At 12 years of age I created what would be the first in a long series of strict 800-calorie-per-day diets (800 calories was my magic number). This first diet was to ensure that I would enter the seventh grade with a knockout figure! I did lose weight, but as most of us know, diets do not cause permanent transformation, nor are they ever a one-time event. The next four years were dominated by diets of all types: grapefruit diets, all-protein diets, no-protein diets, the slimfast diet, the dexetrim diet; you name it, I tried it.

In high school I moved from being uncomfortable with my body to a direct hatred toward it. This hatred fueled my next obsession: exercise. I was able to eat a little more, and my body did change. However, the transformation was not as dramatic as I demanded. I always achieved academically and socially. Why was I unable to achieve the body I worked so hard for? Others seemed to enjoy food with such ease. I was desperate to know how they could eat without guilt and without forcing themselves to exercise up to four hours a day.

In 1987, my sophomore year on campus, a roommate gave me the answer I thought I had been searching for since age 12. 'Eat what you want and throw it up.' She stated this very naturally. She outlined the mechanics of this procedure as I listened in disbelief. Bulimia was a term I vaguely recognized but had never encountered in a conversation. I don't remember when I first forced myself to throw up. I do know that I had careful guidelines for this activity. I only threw up one half of my dinner. This allowed me to eat without guilt and limit the amount of time I felt I needed to exercise. I felt I had found freedom for the first time in many years, freedom from obsessive calorie counting and endless workouts. I even lost weight.

This freedom was fleeting and my obsession with food expanded in dramatic proportions. Within several months I was binging on huge amounts of food several times a day. I spent nearly $200 a week and countless hours filling myself with foods I had been denying myself for years. This cycle of binging and purging became my life. Food became my most coveted relationship. Friends and classes could no longer compete for my time or energy. In desperation I left school to seek help. Shame then kept me from returning to Maryland until 1996, almost 10 years later. I sought in-patient treatment after I left campus. Next, I transferred schools and moved to California. I never escaped my obsession with food. I kept my eating disorder a secret after my first treatment. I felt I had failed and my shame became even greater.

Last year I finally sought treatment again, at a point in my life when I felt that I could not continue to live with this disease. I left my job of five years and took a leap of faith. I trusted that I could find help. I felt compelled to write this column because I have been supported completely during my recovery by others who have suffered as I have. Their experience has given me the confidence and the hope to fight my eating disorder every day. My battle with bulimia is far from over, but each day I experience my relationships with others and life as a whole with a fullness that I have not experienced in my adult life.

The decision not to write this piece anonymously was a difficult one. The faces of those who have shared their experience and hope with me made the decision for me. It is my belief that the more faces put to eating disorders (not just bulimia but anorexia, compulsive exercisers and binge eaters), the more help can be delivered to those that still feel the shame of being alone.

#5

• Anorexia nervosa (AN), characterized by refusal to maintain a healthy body weight and an obsessive fear of gaining weight. Anorexia can cause menstruation to stop, and often leads to bone loss, loss of skin integrity, etc. It greatly stresses the heart, increasing the risk of heart attacks and related heart problems. The risk of death is greatly increased in individuals with this disease.
• Bulimia nervosa (BN), characterized by recurrent binge eating followed by compensatory behaviors such as purging (self-induced vomiting, excessive use of laxatives/diuretics, or excessive exercise) Bulimics may also fast for a certain amount of time following a binge.
• Binge eating disorder (BED) or compulsive overeating, characterized by binge eating, without compensatory behavior.
• Purging disorder, characterized by recurrent purging to control weight or shape in the absence of binge eating episodes
• Rumination, characterized by involving the repeated painless regurgitation of food following a meal which is then either re-chewed and re-swallowed, or discarded.
• Diabulimia, characterized by the deliberate manipulation of insulin levels by diabetics in an effort to control their weight.
• Food maintenance, characterized by a set of aberrant eating behaviors of children in foster care.
• Eating disorders not otherwise specified (EDNOS) can refer to a number of disorders. It can refer to a female individual who suffers from anorexia but still has her period, someone who may be at a "healthy weight", but who has anorexic thought patterns and behaviors, it can mean the sufferer equally participates in some anorexic as well as bulimic behaviors (sometimes referred to as purge-type anorexia), or to any combination of Eating Disorder behaviors which do not directly put them in a separate category.
• Pica, characterized by a compulsive craving for eating, chewing or licking non-food items or foods containing no nutrition. These can include such things as chalk, paper, plaster, paint chips, baking soda, starch, glue, rust, ice, coffee grounds, and cigarette ashes. These individuals cannot distinguish a difference between food and non food items.
• Night Eating Syndrome, characterized by morning anorexia, evening polyphagia (abnormally increased appetite for consumption of food (frequently associated with insomnia, and injury to the hypothalamus).
• Orthorexia nervosa, a term used by Steven Bratman to characterize an obsession with a "pure" diet, where it interferes with a person's life.

Several of the above mentioned disorders, such as diabulimia, food maintenance syndrome and orthorexia nervosa, are not currently recognized as mental disorders in any of the medical manuals.

#4

#3

Nervosa. Those criteria are as follows:
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
(1) eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
(2) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Specify type:
Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas
Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics or enemas

                                                                                                        

            
                              

#2

#1

Eating disorders refer to a group of conditions characterized by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual's physical and mental health. [[it is bad bulimia nervosa, anorexia nervosa being the most common specific forms in the United States^. Though primarily thought of as affecting females (an estimated 5–10 million being affected in the U.S.), eating disorders affect males as well (an estimated 1 million U.S. males being affected). Although eating disorders are increasing all over the world among both men and women, there is evidence to suggest that it is women in the Western world who are at the highest risk of developing them and the degree of westernization increases the risk.

The precise cause of eating disorders is not entirely understood, although, it there is evidence that it may be linked to other medical conditions and situations. One study showed that girls with ADHD have a greater chance of getting an eating disorder than those not affected by ADHD. One study showed that foster girls are more likely to develop bulimia nervosa. Some also think that peer pressure and idealized body-types seen in the media are also a significant factor. However, research shows that for some people there is a genetic reason why they may be prone to developing an eating disorder.

While proper treatment can be highly effective for many of the specific types of eating disorder, the consequences of eating disorders can be severe, including death (whether from direct medical effects of disturbed eating habits or from comorbid conditions such as suicidal thinking).