Anorexia and bulimia: It takes a village

Karen Carpenter, who died of effects of Anorexia

"She's just so skinny.  I wish she would eat more, but she tells me she isn't hungry.  But Madge says her daughter is just like that too and that it's just a phase teenagers go through, that she'll be all right.  I worry, though, as this has been going on for more than a year, and even though she is so thin, she is always saying she needs to lose more. "And it may take a village to help her.

This conversation takes place every day in someone's home, as people observe others who appear to be too thin and worry if there is a problem or not.  Very often the problem is chocked up to a teenage rebellion, an adolescent phase or something that a young person will simply get over with in time.  However, for many people too skinny is a sign of something far more dangerous than someone simply wanting to lose weight.  It is a major health problem that occurs among all age groups and sexes and requires understanding and therapy, sometimes for years.

Anorexia and bulimia are two sides of a coin of concern in many homes.  And in these homes the conversation will highlight many of the misconceptions about these conditions.  These are not individuals who have issues about weight but have health problems that are complex and require special treatment and therapy.

Anorexia is a serious eating disorder, potentially life-threatening.  These individuals seek to lose far more weight than is necessary and seek to weigh less than is normal for their height and age.  They have an intense fear of eating too much and will exercise, diet or purge themselves of food in order not to consume what they consider is too much food.

90% of those who are anorexic are female.  Many of them began having eating problems when they were teenagers.  It is common for the condition to begin during the adolescent years.

The condition, anorexia, can be such a problem that many people end up in the hospital with health problems related to not eating much or not eating the proper amount and types of food to sustain good health.  According to experts, a person can be considered anorexic if he or she drops below 15% of normal weight.

There are frequently rituals involved with eating when someone is anorexic.  The silverware may need to be just so, the cleanliness of concern, and the condition of the food itself is of consequence.  They may refuse to eat in front of other people, or eat in some hidden place where no one can watch or criticize.

For someone who is anorexic thoughts about food can occupy much of the day.  Thoughts about dieting, what to eat and what not to eat, the need to constantly exercise and the anxiety about not being thin enough are a constant part of an anorexic's life, one that is filled with worries about weight.  Furthermore these thoughts are often coupled with feelings of poor self worth and lack of personal power.  It is a self-destructive pattern that is difficult to break.

While anorexia is a separate condition, there are many people who suffer from both anorexia and bulimia.  The person with bulimia gorges on relatively large amounts of high calorie foods from which they need to "purge" themselves.  During a binge, an individual may consume as much as 3000 calories or more, then feel a sense of shame because of it.  Diuretics, laxatives and enemas become the tools for relieving the anxiety, by purging the system of the food, so that the guilt can be washed away with it.

Bulimia comes about as a consequence of genetics, being bullied, having strong feelings of hopelessness and a lack of self worth, being a victim of abuse, or having mental health problems.  Some of these individuals are involved in occupations where one's weight is critical to maintaining a job.  Many models feel the pressure to remain slender, so when they eat more than the ordinary amount of food, they reach for something to purge the food so it does not contribute to weight gain.

These conditions, anorexia and bulimia, create serious problems for families and for the individuals as well.  Often it is the family and friends that can offer someone the support necessary to break the cycle, to get help and get healthy.  But it is a difficult road, once habits are entrenched; and some people end up dying, like Karen Carpenter, the famous singer-entertainer, did at a very young age.  Knowing the facts, the causes and the treatments available, however, can bring people back to normal weight and a normal life, as Jane Fonda, the actress who suffered from both conditions, likes to reiterate.  In other words, there is help and treatment, but the road back can take time, understanding and the affection and support of a "village" in the person's life.