October 4, 2007

Dr William Reville

Under the Microscope: Most people who suffer from an eating disorder have a distorted image of their own bodies. When they look in a mirror they don't like what they see. Some treatments for eating disorders tackle this body image problem head on as one strand of a multi-strand approach to curing this problem.

This distorted body image problem is described by C Eggers and Verena Liebers in the April/May 2007 issue of Scientific American Mind.

Eggers and Liebers describe eating disorders as complex psychiatric conditions caused by inborn and circumstantial factors. Distorted body image is a reflection of poor self-esteem, based largely on emotion and is affected by others' opinions and cultural ideals.

There are three main forms of eating disorders and, in declining order or seriousness, these are anorexia nervosa, bulimia nervosa and binge eating. At least 10 per cent of people who suffer from an eating disorder are men. It is estimated that between 0.5 per cent and 3.7 per cent of women develop anorexia and 1.1 per cent to 4.2 per cent experience bulimia in their lifetime. The incidence is rising in the developed world.

Anorexia nervosa usually develops around puberty. Sufferers from anorexia starve themselves, exercise obsessively, but even when clearly emaciated still think they look too fat. They become out of touch with body sensations and don't register hunger, cold, heat or pain very well. Women often stop menstruating and men can become impotent. Many become obsessed with control and performance. About 30 per cent of anorexic women recover fully. About 35 per cent partially recover, ie regain some weight but retain a distorted body image. About 25 per cent remain chronically anorexic and 5.6 per cent die from starvation or suicide.

Bulimia nervosa usually develops between the ages of 18 and 35. Sufferers alternate between starving, bingeing and purging. Bingeing means gorging on calorie rich food. Purging means regurgitating the food by inducing vomiting, or also inducing voiding by taking laxatives. Regurgitation of food has serious side-effects. Stomach acid erodes teeth and damages cells in the oesophagus, possibly leading to cancer later. It also causes dehydration and loss of important electrolytes which can cause organ damage. Victims of bulimia often are not noticed because they hide their bingeing/purging. Bulimics who seek treatment have a 50:50 chance of full recovery.

The term binge-eating describes the condition – regular consumption of large amounts of food. Often binge-eating is a precursor of bulimia nervosa. Anorexia, bulimia and binge eating exist on a continuum and are usually preceded by a period of dieting.

Many studies confirm the distorted body image syndrome in eating disorders. Eggers and Liebers describe research in which 56 people with eating disorders and 209 healthy control subjects were asked to adjust their images on a computer screen until they "recognised" themselves. All the subjects had similar notions of the "ideal" figure, but all the bulimics and anorexics overestimated their real body mass. Many researchers are convinced that faulty body image is crucial to the development of eating disorders.

Deep-seated feelings of inadequacy and low self-esteem seem to lie at the root of eating disorders. We develop our basic sense of security and self worth during childhood and it depends to a great extent on healthy and caring parental nurturing. Unfortunately, studies show that about 30 per cent of children are handled poorly in this critical phase and emerge feeling insecure and unaccepted. Such people are at risk of falling prey to eating or other addictive disorders.

Eating disorders occur in all kinds of families, but some trends are discernible. Eating disorders often develop in well-educated, economically comfortable families where the parents set very high standards, negative emotions are suppressed and children feel under pressure to perform to the highest standards. Children can emerge determined to live model lives but nevertheless feeling deep down that they just don't measure up.

Other studies have shown that children who suffer sexual abuse are particularly at risk of developing eating disorders. Children of alcoholic parents or divorced parents are also at increased risk.

It is important for parents to be loving and supportive of their children, to encourage healthy eating and to make regular exercise an enjoyable and rewarding activity. The importance of physical appearance should be de-emphasised and we should remember that a healthy inner essence will shine through any physical package in a beautiful manner.

There is relentless pressure on women in modern culture to live up to the "ideal" body image portrayed everywhere – from Hollywood to the picture on the cereal box. This is illustrated by a study of eating disorders in Fiji described by Eggers and Liebers. In 1995, immediately after TV became available on the island, only three per cent of schoolgirls (average age 17) reported they had vomited to control weight. That number had increased to 15 per cent in 1998 and 74 per cent reported sometimes feeling "too big or fat" even though the traditional culture associates substantial body shape with higher social status.