Eating Disorders: purging the dragon within

A young student stares into a mirror and, despite her emaciated condition, she vows to lose just another five pounds. Then she will be happy and her life will fall into place. An energetic athlete flees to the bathroom to vomit the forbidden food consumed in the fury of a binge, fearing that someone might soon discover the secret.

Many people express unhappiness with their appearance, and dream about how much better life would be if they could just lose five or ten pounds. Concerns about food and body image are not uncommon in our society. Unfortunately, what might start as an innocent diet can, for some, quickly spiral into a serious eating disorder.

Anorexia Nervosa is a disorder characterized by a refusal to maintain a healthy body weight (usually 15% below normal). The individual works very hard to control the urge to eat and tends to derive an increased sense of self-esteem from having lost weight. Some people with anorexia become dangerously emaciated, yet continue to see themselves as too heavy. A person struggling with Bulimia Nervosa binges on food and then uses a form of purging, such as vomiting, excessive exercise, or laxatives in an attempt to prevent weight gain. Johnston says that it is not uncommon for a person to initially develop anorexia and then develop bulimia later on. Victims of both disorders experience extreme anxiety and distorted perceptions of their shape and weight. Compulsive overeating, which is much more common than bulimia or anorexia, also involves body distortion, yet usually these distortions are not as severe as those in the other two disorders.

Thin Ice

Jennifer Saunders*, a good friend of mine, struggled for years with a vicious eating disorder. Jen's prospects for a happy, healthy life were overshadowed by a tyrannical dragon, called anorexia, which ruled her existence. She first started having problems with food when she was 14 years old. She had symptoms of the disorder all through high school graduation, but it wasn't until after graduation that her health deteriorated severely.

Jen was referred to a program for eating disorders, but this treatment did not seem to help. At one point she became so ill, she had to be hospitalized.

During this period, she spent a lot of time outside smoking, because it was an outlet for her anxiety as well as a way of avoiding food. I will never forget visiting her there. She was totally emaciated, a complete skeleton, and evidence of her bony limbs could not be hidden by her baggy pajamas. Sitting there watching her in this terrible condition, shivering with cold and puffing away, was like witnessing a suicide. I knew she was going through pure hell.

Why was this happening? What was she doing to herself? Couldn't she see that she had so much to live for? These questions were on the minds of many people. Jen had a family that loved her, lots of friends, a bright future. How had this destructive illness captured such a tight grasp on her life? She was walking on thin ice, flirting dangerously with death. I actually envisioned myself attending her funeral.

Fortunately, Jen was able to find help. Soon after being hospitalized, she entered a three month out-patient program at St. Paul's Hospital. It was a very intensive program that focused on the psychological aspects of the eating disorder as well as the physical and nutritional issues.

Initially, says Jen, she hoped that someone would 'wave a magic wand" that would "get rid of the eating disorder overnight." Of course, that didn't happen. Instead, she was forced to confront her fears and discovered that a lot of her eating disorder was based on issues of control. By focusing on food and her weight, she was able to block out many underlying issues that were upsetting her.

In therapy, she realized that she was "afraid of growing up," and saw how her anorexia was a way to avoid dealing with her future. Her perfectionistic, black-and-white thinking fueled the cognitive distortions surrounding her eating problems. Parental pressure, which emphasized academic achievement, also contributed to the disorder.

Fortunately, Jen was able to recover and is now able to confront her problems head-on without punishing herself with eating disordered behaviour. Sometimes, she admits, there are days when she wants to slip back into "the secure little cocoon" of anorexia but she knows that is not the type of life she wants to lead. The realization that her eating disorder prevented her from moving forward with her life serves as ammunition against a relapse. In her words, "anorexia steals your future and you know that you can't have a real future if you continue with the eating disorder."

Living with the dragon

If you are struggling with an eating disorder, you are not alone. Conservative estimates based on studies conducted in Britain and the U.S. suggest that 1 in 100 people become bulimic and 1 in 1000 become anorexic. But there are many more people who struggle with eating problems who are not considered in the statistics because their symptoms do not satisfy diagnostic criteria.

Cynthia Johnston, Director of the Eating Disorder Resource Centre of BC, based at St. Paul's Hospital in Vancouver, stresses that while "anorexia is certainly a serious problem," it is essential that people "recognize that eating disorders are not just about this particular disease."

While many people call the resource centre with concerns over anorexia or bulimia, staff handle more calls from people struggling with compulsive eating.

It is unclear, says Johnston, if 'dieting causes eating disorders, [but] it certainly seems to be a prerequisite." When people diet, their weight goals often conflict with their "set points"-the natural weight at which the body is designed to function. The clash can produce a battleground in which food and weight preoccupations wage war with biology.

While eating disorders were once thought to exclusively affect those in certain socioeconomic groups, Johnston says "eating disorders have really crossed the bounds." Just about anyone can develop an eating problem.

Johnston has found that compulsive eating tends to affect men and women equally, while anorexia and bulimia generally are far more pervasive in the female population. Between five and ten per cent of the people who inquire at the resource centre, Johnston estimates, are men. From statistics at the centre, there appears to be a large incidence of eating disorders in university and college populations.

The resource centre doesn't just hear of concerns regarding adults, either. They sometimes get calls from people worried about children, often distressingly young. "Very often in those situations," says Johnston, "it seems that the behaviour has been learned from the parent or someone who spends a lot of time with the child." Sometimes, she adds, this is "what finally gets a parent into treatment."

It's important for people struggling with eating disorders to have access to help. Often people will say that they will never binge again or they will stop starving themselves, but eating disorders can go on for years if the individual does not get help.

When people call the Eating Disorder Resource Centre, they are recommended to see a medical doctor, who will refer them to a specialist. Medical monitoring is necessary, Johnston maintains, because "while individuals can often fully recover, some people do irreparable damage to their bodies with eating disorders."

Eating disorders can result in dental problems, such as cavities and receding gums. This can be due to the foods people tend to eat during binges, or caused by poor nutrition in general. Bulimics who use vomiting as a method of purging often have dental problems because of the acid that remains in the mouth after vomiting. People's organs can also be affected. Heart abnormalities, bowel and intestinal problems, and osteoporosis can all develop as a result of eating disorders.

If an adult seeking help lives in Vancouver, Burnaby, or Richmond, he or she is referred to St. Paul's Hospital. Referrals for children are made to the B.C. Children's Youth Clinic. People living on the North Shore or in Coquitlam, Surrey, and the surrounding areas are referred to a local Mental Health Unit which offers eating disorder programs for both adults and youths. Here, Johnston says, people can receive education on the dynamics of eating disorders, but the 'problem is that their mandate [at Mental Health] is not long-term treatment."

While St. Paul's offers more intensive programs, some as long as three months, there are often long waiting lists. Furthermore, Johnston adds, "attending a treatment program is only part of one's recovery. People may do really wee, particularly if they have been in a very intensive environment with lots of support." She has seen "people who come out of programs and feel like they are on cloud nine and that they have overcome the eating disorder." But she acknowledges the need for "ongoing support." It is important that people in recovery "understand that there may be a tendency to relapse, especially if they are going back into their regular environment."

In treatment, it is important for people to look at "the underlying issues to the eating disorder," so that they become aware of "what is perpetuating the disorder, what is leading [them] to not feel very good about themselves so that they are turning to these behaviours." Treatment gives people tools to overcome their disorders. Through the development of a close relationship with a therapist, or in a supportive group environment, people can learn to use healthy coping strategies, so that they can deal with difficult issues as they arise, instead of keeping them bottled up inside.

Eating disorders develop in many people because they act as survival strategies in times of stress. It does not matter if a person "turns away from food or turns to food and purges," says Johnston, the main issue is that people are "using food as a way of coping." Cultural factors which emphasize the importance of thinness, as well as family issues, individual personality, and biological conditions all have the potential to influence the development of disordered eating. Eating disorders seem to be multidimensional problems, therefore people will usually need to explore various avenues in order to find sufficient help. In addition, a particular tool or therapy that works for one person may not necessarily work for someone else. Treatment depends on the individual.

One of the most important concepts to keep in mind when confronting eating disorders is to recognize that food is not the only issue involved. Disordered eating patterns are symptoms of more complex issues which need to be addressed if people are to overcome their eating problems and achieve physical and psychological well-being.

February 5-11 is Eating Disorder Awareness Week and there are many events taking place, mostly free of charge, throughout the Lower Mainland. Information is available on bulletin boards throughout the SFU Burnaby campus. Presentation on eating disorders will be made on Monday, Feb. 5 at 7:00 p.m.at SFU's Shell House Residence, and on Tuesday, Feb. 6 12:30 to 2:00 p.m. at Halpern Centre.

For more information, call the Eating Disorder Resource Centre at 631-5313 in Vancouver, or 1-800-665-1822 throughout the rest of BC.

ANAD offers free, ongoing support groups in various locations around the Lower Mainland for those with anorexia and/or bulimia and for their families and friends. Call 684- ANAD (2623) for more information.

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