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Starving for Attention STORY BY

Nora K. Shire

Part I of a Series
on Eating Disorders

For a girl, that infamous biological clock begins at the stroke of puberty. Unfortunately, many females unwittingly hinder its onset or bring it to a halt by strenuous exercise or by dieting. It spirals out of control though, with eating disorders such as anorexia nervosa and bulimia nervosa.

If this over-exercising, dieting adolescent girl is 15 percent below a normal body weight and height for her age, she can stop her body clock altogether. And she can create irreversible damage.

'To die for'

The physical consequences are serious and can be life-threatening: 10 percent of females with anorexia eventually die from the disease. Semi-starvation affects most major organ systems in the body and produces a variety of disturbances such as arrhythmia (abnormal heart beat).

They have no periods. They starve. They are terrified of weight gain. Yet, they deny any illness.

Mirror, mirror on the wall

Body image is the measure of self-worth, especially at this formative age. In bulimia nervosa, the primary trait is binge eating followed by purging. Some vomit. Some use laxatives. Some do excessive exercise. They see in the mirror an unacceptable body shape and weight. Those suffering with eating disorders also will frequently have anxiety or depression and may show signs of obsessive-compulsive behavior.

With anorexia, the whole system may shut down. Puberty is delayed or stopped. The metabolism slows and there are changes in thyroid hormone. In bulimia, the repeated vomiting may cause electrolyte abnormalities such as plunging potassium. Dehydration may occur.

"These young women have significantly low bone mass because bone health is dependent on adequate amounts of estrogen which does not begin until a female is menstruating," Dr. Shahla Nader explains. "Peak bone mass is reached in the mid-20s, and after 30, plateaus. That lost time cannot be regained."

Nader, a professor at The University of Texas Medical School at Houston in the departments of Internal Medicine and Obstetrics, Gynecology and Reproductive Sciences adds that even prescribing hormone replacement therapy cannot fix the bones that have suffered from nutritional deficiencies due to poor eating habits.

"Nothing tastes as good as 'thin' feels"

Psychologist Camille Lloyd says that eating disorders-especially anorexia nervosa-are complex conditions that challenge researchers to find the root cause.

"Biological, social and psychological factors all play a role. We know that there is a genetic predisposition that may affect the regulation of serotonin [brain chemical messengers] in some patients. Social factors that place a high value on thinness, considering it essential to attractiveness, also contribute to the development of the disorder," Lloyd observes.

"Other factors are negative childhood experiences, such as sexual abuse, and psychological features such as low self-esteem, perfectionism and excessive concerns over control." Lloyd is also director of Student Counseling at the Health Science Center and a professor in the Department of Psychiatry and Behavioral Sciences at the medical school.

For most teens, healthy self-esteem develops from a variety of factors, such as making good grades, playing a sport well, and being a good person as well as a good friend, Lloyd explains. But for those with eating disorders, the self-worth gets skewed.

"It largely gets funneled down to one question: how thin am I? Body weight gets overvalued, and they are typically very self-critical. Anorexia is difficult to treat, and some individuals will be plagued for years with a chronic condition," Lloyd says. Most will not admit they have a problem, because to them, losing weight is an achievement.

People with bulimia, on the other hand, know they are binging with excessive amounts of food and then purging, and these binges are more likely to be a source of distress. Also, bulimia may have a later age of onset.

Hope and treatment

"One source of help for the anorexic can be cognitive-behavioral therapy, which begins with getting the patient to admit there is a problem. Motivating them to want treatment and maintaining that motivation are the challenges," says Lloyd.

"Treatment often involves careful negotiation because they are afraid of every pound they gain. No drugs have been found to successfully treat anorexia, although there is preliminary evidence that anti-depressants may be helpful in keeping some individuals from relapsing."

In the bulimic patient, anti-depressants can help reduce the frequency of binging and purging. Selective serotonin reuptake inhibitors (SSRIs) like Prozac, are useful, as well as cognitive behavioral therapy. Bulimic individuals also have an abnormal attitude toward their body, but because they are so restricting, they get hungry, and sometimes just getting a patient to eat more regularly helps break the destructive cycle.

An estimated one-half to one percent of females 13-18 has anorexia. Adolescents with bulimia rarely die from their disease, yet 1-3 percent of this same age group suffer from this condition and its adverse psychological and medical consequences.

Concerned parents should watch for these eating disorder warning signs:

Last Updated: 12-08-2003