ANOREXIA AND BULIMIA: WHEN BEAUTY BONES LOSE THEIR BEAUTY

Demi Lovato, our Disney Star, has confessed, “‘Food is still the biggest challenge in my life and it controls — I don’t want to give it the power to say it controls my every thought, but it’s something that I’m constantly thinking about…Body image, what I’m going to eat next, what I wish I could be eating, what I wish I didn’t eat. It’s just constant…” 

Princess Diana revealed in one of her interviews, “The first time I was measured for my wedding dress, I was 29 inches around the waist. The day I got married, I was 23-and-a-half inches. I had shrunk into nothing from February to July.”

Portia de Rossi, an Australian-American model, actress and spouse of Ellen DeGeneres, has stated in her memoir, “Since I was a 12 year old girl taking pictures in my front yard to submit to modeling agencies, I’d never known a day where my weight wasn’t the determining factor for my self esteem. My weight was my mood, and the more effort I put into starving myself to get it to an acceptable level, the more satisfaction I would feel as restriction and the denial built into an incredible sense of accomplishment.”

These women along with many other celebrity figures have suffered from EATING DISORDERS. An eating disorder is a disturbed pattern of daily food intake (either eating too little or too much) along with high levels of unnecessary distress associated with body shape, size and weight. While Demi Lovato and Portia de Rossi suffered from Anorexia Nervosa (AN), Princess Diana was diagnosed with Bulima Nervosa. At the outset, it is important to note that even though the prevalence of eating disorders is higher in females than in males, we have witnessed several male celebrities to the likes of Eminem, Elton John, Russel Brand and others come forward to be open about their struggles with eating. Another common misconception better corrected at this point is that Eating Disorders are not the “disease of the rich”. Yes, it is through the stories of these high-profile celebrities that we have come to know of maladaptive eating behavior patterns. In fact, Princess Diana was one of the first prominent personalities to disclose her body image related issues which reportedly doubled the rate of women seeking treatment for Bulimia in the Great Britain. This came to be dubbed by the media as the “Diana Effect”. It may also be true that the work industry demands of maintaining a particular “body type” may play a major role in these models, actors, singers or royal family members in developing such disorders. Still, this is no reason why someone you know or love may not suffer from a similar condition.

Anorexia Nervosa

An individual is said to be suffering from Anorexia Nervosa (AN) when s/he shows the following three symptoms:

1.      Severely restricted eating which results in the person being 85% of the expected body weight for people their height, sex, age and physical health.

2.      Fat phobia: Intense and irrational fear of putting on weight.

3.      Disturbed self-perception of body shape and weight such that they view themselves as being fat even when in reality they are actually very thin—at times, dangerously thin.

What do I mean when I say “dangerously thin”?

It means that a person with anorexia may lose so much weight that they may actually be at the risk of dying from being underweight. In fact, research has found that out of all mental illnesses, the mortality rate is the highest for those suffering from eating disorders. This might be so because depriving our body of all vital nutrients to such a drastic extent often results in a number of physiological complications such as weakness and brittleness of bones, muscles, hair and nails; low blood pressure, slow breathing and pulse rate; lethargy and fatigue; heart and brain damage and the possibility of multiple organ failure. Although no longer applicable, earlier the criteria for assignment of this clinical diagnosis to women required that the patient stops menstruating completely. Nevertheless, a majority of women with AN don’t menstruate and experience infertility.

There are two major types of Anorexia Nervosa:

In the restricting type of AN, the individual doesn’t engage in binge eating. They simply refuse to eat or engage in excessively strenuous exercise schedules as a means of preventing weight gain.

However, in the binge eating/ purging type, the individual occasionally engages in binge eating of food items followed by means of ridding their bodies of these extra calories by either self-induced vomiting or use of laxatives and extreme exercising. Nevertheless, these individuals continue to remain significantly underweight as they may not necessarily consume a lot of food when they eat, but even such small amounts may make them feel as if they have binged.

An interestingly baffling quality of an individual with AN is that they fail to feel as if there is anything wrong with their eating habits or body image. They show extremely high self control and don’t experience hunger pangs. They often eat the little amount that they do due to force feeding from family and friends. They are less likely to be overweight in the past. Thus, their desire to reduce weight is often driven by an independent and erroneous evaluation of their own “fatness” rather than the need for seeking approval from others.

Bulimia Nervosa

The diagnosis for this disorder is given when an individual meets the following criteria:

1.      Eating excessive amounts of food containing about 3,400 calories within a time period as short as about 2 hours. This might be referred to as binge eating.

2.      Feeling absolute lack of control over eating while engaged in these binge sprees.

3.      Follow up compensatory purging behaviors like self induced vomiting, use of laxatives and diuretics, other medication, fasting or extreme exercising in order to prevent weight gain.

4.      Exhibiting this cycle of binge eating-purging at least once per week for a period of 3 months.

5.      Sole dependence of self esteem on body weight and shape.

6.      Binge eating-purging episodes shouldn’t exclusively occur at the time of meeting all the symptom requirements for anorexia.

An important fact to support the last point is that an individual with bulimia is almost always of the normal weight or slightly overweight which results in failure to make a diagnosis most of the time. In addition, these individuals are very well aware that their eating styles are maladaptive and so their ritualistic binge eating & purging is often kept a secret. Consequently, suicide rates are somewhat higher in this group than those with anorexia as a strong sense of embarrassment is felt by individuals with bulimia. Further, they have a fairly realistic perception of their body shape but are dissatisfied with whatever weight they are at. Their disorder usually is an off-shoot of some critical comments from a significant someone in their life or due to other stressful life situations like marital conflict. For instance, Princess Diana has reported an incident where Prince Charles held her love handles and called her chubby which led her secret journey into the depths of bulimia. Thus, differing from anorexia in important ways, sufferers of bulimia have often been overweight at some point in the past. Also, they are likely to experience strong hunger pangs which when combined with emotional instability may lead them to engage in impulsive eating.

Medical problems undoubtedly follow such erratic feeding patterns. Ipecac syrup used for inducing vomiting have severe toxic effects if taken regularly in large doses. Self induced vomiting also results in dental decay due to the high acidity of thrown up material. This binge-&-purge cycle often causes dehydration which may result in permanent gastrointestinal damage, fluid retention in hands and feet, and heart muscle & valve destruction or collapse.

These disorders compel us to spend a moment of introspection about how body image troubles lead to such severe mental disturbances in something as basic as feeding yourself. Stay tuned for upcoming posts on other related conditions stemming from bodily insecurities.