At first her parents didn't notice the subtle changes in Kathy's appearance and behaviour. A top athlete and honour roll student, she was always critical of her body size and shape. She would exercise compulsively, doing sit-ups, doing pushups, and running up and down the stairs. Although she seemed preoccupied with food, she became a vegetarian and would leave most of her food uneaten at meals. Gradually she became withdrawn, depressed, and always tired. She stopped having periods. Then one night at a basketball game her parents watched with concern as this skinny kid, no longer a high scorer, was knocked over by another player. Kathy's mom took her to their family doctor who told them about anorexia nervosa and started her on medication. Kathy was referred to a psychiatrist skilled at cognitive behavioural therapy for eating disorders. They visited the local eating disorders resource centre for reading materials and to find out about community resources. Her parents began attending a support group for family members of people with disordered eating. Now, 2 years later, the family is doing well, Kathy still sees a counsellor every month and takes medication, but she feels pretty good about herself and is back at the top of her game.

Kathy and her family were lucky; eating disorders, if left untreated, can be fatal.

While as many as one third of North Americans are obese, the media bombard us with images of underweight, twig-like prepubertal-shaped females. Although the rates vary tremendously depending upon age and setting, between 0.1% and 1% of young women suffer from anorexia, and bulimia is about three times more prevalent than anorexia. Compared to males, females are 10 times more likely to have eating disorders, and there is higher prevalence in those who participate in competitive sport, ballet, or modeling. About one-fifth of those going to weight-loss clinics suffer from compulsive eating or binge eating disorder.

The diagnosis of anorexia is based on behaviours that result in marked weight loss, a morbid fear of becoming fat, and evidence of hormonal changes such as loss of menstruation in females due to starvation. Bulimia is characterized by recurrent episodes of binge eating followed by attempts to get rid of calories through vomiting, laxatives, diuretics, or exercise. A distorted self-perception of body shape and size with self-esteem linked to body image are other characteristics. People with binge eating disorder rapidly consume large amounts of food - feeling a sense of loss of control once the binge has begun and experience shame and embarrassment over their eating behaviour.

Theories abound about the causes of eating disorders. Quickly eating large amounts of high-calorie foods results in surges of brain chemicals such as serotonin, dopamine, and endorphins, resulting in elevated mood and sedation. Starvation causes a mood-altering stress response in which adrenaline-like compounds and cortisol are elevated. Some experts feel that control is a big issue for the person with disordered eating: in a scary, confusing world in which they have no control, what they eat is the one thing they can totally control. People with eating disorders often judge self-worth in terms of their shape and weight, they are perfectionists, and they see things as black or white, good or bad, or all-or-nothing. Like the binge drinker or cocaine addict, the bulimic or compulsive overeater will often alternate between periods of self-denial and abstinence and episodes of binge eating in order to relieve stress and achieve comfort followed by feelings of guilt and remorse.

If you or someone you love has an eating disorder, get some help. Read the information on this website and visit related links and sites. Call your mental health agency and ask for eating disorder programs and therapists in your community. There is good evidence that cognitive-behavioural psychotherapy is effective. There are several support groups both for the person with disordered eating as well as for family members. See your family doctor. Some of the newer antidepressants have proven effectiveness when coupled with psychotherapy. As with many other chronic illnesses, earlier recognition and treatment results in better outcomes.

  Ray Baker, MD
iWith updates by the MediResource clinical team