Eating Disorders

Anorexia and bulimia are eating disorders affecting a significant number of adolescent and young adult women. The core symptoms of both disorders are similar and include a fear of obesity, body image disturbance, erratic eating patterns, and purging. These symptoms produce significant physical and psychologic complications. Both anorexia and bulimia appear to have a common origin in a fear of obesity and dieting. Anorectics, being "successful" dieters, lose a significant amount of weight; whereas bulimics alternate between binges and purges. Treatment for the eating disorders is gradually evolving as clinical research experience accumulates. For anorexia, hospitalization is indicated when weight falls below 15% of ideal, and most investigators agree that therapy for the core symptoms cannot be undertaken until weight is restored. During the impatient stay, a behavior modification program can effectively organize medical, nutritional, and psychologic support, and offers the quickest and most direct route to weight restoration. The nasogastric tube and total parenteral nutrition are used primarily for those who are severely emaciated or who actively resist standard modes of therapy. Inpatient treatment is most effectively and efficiently rendered in a specialized eating disorder unit. Once weight restoration is progressing, behavior therapy for core symptoms is commenced and continued on an outpatient basis. A variety of behavioral techniques are employed, and they are designed primarily to influence anorectic assumptions and beliefs. Although there may be a brief inpatient stay for initiation of treatment, the bulk of therapy for bulimia occurs on an outpatient basis. The available literature indicates that behavioral techniques and antidepressant medication are effective for the symptoms of bulimia. Early identification of core symptoms of both disorders can lead to an initiation of treatment before the core symptoms become ingrained. A potentially more effective intervention lies in efforts to influence the media. As noted, standards for feminine beauty as portrayed in the media have changed significantly over the past 20 years. An attempt at the primary prevention of eating disorders would include efforts to convince the media to change their standards of femininity from cosmetic slimness to a focus on health and physical fitness. These efforts could stem from professional and lay organizations who have the interest and capability to influence policy.