Eating disorders develop from a variety of weight, food and psychological issues that can be experienced by both male and females. Conditions such as anorexia nervosa, bulimia nervosa, and compulsive overeating are serious emotional problems that you may come across in your family, work or friends.

Considering the fact that these conditions may be life-threatening, it is important to develop a good understanding of the symptoms and be able to recognize these disorders. You may even read this and it might remind you of someone you are really close to!

Generally, eating disorders refer to inappropriate eating habits, weight management methods and attitudes about weight and body shape. These eating-related attitudes and behaviors result in a loss of self-control, feelings of obsession, anxiety, and guilt, alienation from self and others, and physiological imbalances which are potentially life-threatening. The most common element relevant to all eating disorders is the presence of a low self-esteem.

People with eating disorders are often thought of as being underweight; but they can also be overweight or even normal weight. This obsession and pre-occupation with food, food intake and self image can extend to not eating enough, fanatical dieting, bingeing on large quantities of food, and purging food before it can be absorbed by the body. Eating disorders are far more common in women than men, especially women aged 15-25 years.

It's often difficult to tell when someone is developing an eating disorder because he or she will work very hard to hide it. Secretive behavior, such as hiding binge-purge behaviors due to shame, is very common.

The two most common eating disorders are anorexia nervosa and bulimia nervosa.

ANOREXIA NERVOSA

People who intentionally starve themselves, or who do not eat enough to maintain a healthy body weight, suffer from anorexia nervosa. Anorexia is most common amongst girl's aged 13 to 17, peaking at age 15, and involves extreme weight loss, with sufferers often weighing 15% less than their normal weight for height. Anorexia is probably caused by a combination of social pressures, personal factors, and biological vulnerability, although the underlying causes will differ between individuals.

Listed below are a number of physical, behavioral and psychological characteristics that may become evident in people who you suspect may be anorexic. Be aware that all symptoms may not necessarily be evident simultaneously and the existence of one or more of these symptoms does not necessarily lead to anorexia nervosa.

Physical Symptoms

• Skin and nail problems.
• Loss or thinning of hair.
• Sensitivity to cold.
• In females; irregular (loss of three consecutive menstrual periods) or no menstruation (amenorrhoea). In pre-pubescent girls, periods may never start.
• Growth of fine body hair (lanugo).
• Complaints of constipation.
• Tiredness from insomnia.
• Marked weight loss as a result of deliberate starvation or a rigid diet.

Behavioral Symptoms

• Excuses for not eating food.
• Excessive exercise or hyper-activity in an attempt to lose more weight.
• Frequent weighing of body weight.

Psychological Symptoms

• Low self-esteem, low self-worth and a strong sense of ineffectiveness, however, they seldom recognize that they have a problem.
• Depression. (Some will voice suicide intention)
• Perfectionism, perfectionist ideals - expecting excellence in everything. A strong determination to become thinner and thinner. They are often hard working over-achievers.
• An intense and irrational fear of body fat and weight gain (this fear does not decrease with weight loss)
• Distorted body image and claim to feel fat even though emaciated.
• Constant pre-occupation with thoughts of food.
• If not treated, anorexia can lead to serious physical problems such as malnutrition, damage to the heart and kidneys, and even death.

BULIMIA NERVOSA

People with bulimia nervosa eat large amounts of high-calorie food in a short period of time, then vomit and/or use laxatives to purge the food before the body can absorb it. This condition is also known as "bingeing and purging". Bingeing and purging are recurring events that typically alternate with extreme dieting.

As with anorexics, not all the symptoms of bulimia may be evident simultaneously and presentation of one or more of these symptoms does not necessarily lead to bulimia.

Physical Symptoms

• Near average weight or slightly over or underweight.
• Dramatic weight fluctuations brought about by frequent binge eating and purging.
• Swollen salivary glands, puffy cheeks and chronic hoarseness. Forced vomiting can cause blistering, tearing and bleeding of the throat and esophagus.
• Dental decay from stomach acid (erosion of the enamel layer, dental cavities).
• Disturbance of the menstrual cycle.
• Hair, nail and skin problems.
• Complaints of constipation (laxative, diuretics and emetics may contribute).

Behavioral Symptoms

• Purging may take the form of fasting or excessive exercise.

Psychological Symptoms

• Low self-esteem, poor self-image.
• An overwhelming fear of becoming fat with great importance attached to being slender.
• Constant pre-occupation with food.
• Feelings of guilt, shame and self-loathing, often helping them to realize that they have a problem as they become depressed after binges.
• Depression and at times, suicidal thoughts.
• Mood swings and increased irritability.

If left untreated, bulimia may cause dehydration, the depletion of important minerals, and damage to vital organs. Bulimia nervosa is more common than anorexia, occurring most commonly in older teenage girls and women in their twenties.

Milder forms of both anorexia nervosa and bulimia nervosa also occur. They should be taken seriously because the condition may worsen. Other common eating disorders include compulsive overeating, in which a person binges but does not purge as with bulimia. While almost everybody over eats occasionally and minor deviations are normal, it becomes a disorder when things get out of control.

EARLY TREATMENT IS VITAL

So how can you help?

The sooner an eating disorder is spotted and treatment began, the better the outlook. You can encourage the person to seek treatment from a mental health professional, or at least see their family doctor. Doctors can perform a physical exam to determine if the eating disorder has caused any physical harm and to rule out any other explanation for weight loss such as gastrointestinal or endocrine disorders.

The next step is usually education about proper nutrition and psychotherapy while the adolescent remains at home. Counseling for the parents is also recommended. If the weight loss or bingeing and purging are out of control, hospitalization for more intensive treatment may be required. It is important to note that these are complex problems; and there is no simple solution, and medical professionals may vary in their approach.

At times it may be difficult to say anything to someone you suspect of having one of these disorders, but ultimately in the end you may be their only help and you may even save their life. A good idea is to obtain some reading literature on the disorder, such as this article, and mail it to them anonymously.

REFERENCES
1. Eating Disorders by Mary Pipher. Published by Vermilion Books
2. The European Council on Eating Disorders
3. American Anorexia/Bulimia Association -Andrew Cate AsDip Sp Sci., BHMS