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EATING DISORDERS

The "Disease of Abundance."

When Karen Carpenter, a member of the popular singing duo The Carpenters, read a review that called her "chubby," she began an eight-year obsession with her weight. By 1983, when she died from heart failure from emetine poisoning brought on by taking ipecac to induce vomiting, anorexia and bulimia had become household words. American society was obsessed with dieting, and these puzzling and frustrating disorders were extreme examples of the national obsession with weight and appearance.

Anorexia Nervosa

Anorexia was a form of extreme self-starvation and distortion of body image. Patients refused food until they reached a point of severe emaciation or even death. Even though looking in a mirror should tell them that they were too thin, they persisted in seeing themselves as too fat and were proud of their control over food. The term anorexia which means "lack of appetite," was first used in England by physician Sir William Gull in 1873. Although anorexia was better defined as an obsession with food, Gull was also the first to note its prevalence in young upper-middle-class girls. In the 1980s it occurred most commonly among adolescent women. As it became more common during the decade, estimates of its incidence among young women in the United States were as high as one in one hundred teenage girls and young women. Unlike other psychological disorders that are more randomly distributed, anorexics had many social traits in common. Anorexia was fifteen times more likely to be found in females than males, typically began in adolescence, and, as Gull noted, was most common in wealthier families.

Bulimia

Little known even by physicians before the 1980s, bulimia was first thought to be an aspect of anorexia nervosa. It was characterized by secretive episodes of uncontrollable eating binges followed by self-induced vomiting to prevent weight gain. Bulimics differed from anorexics in terms of their loss of control over their eating. The anorexic prided herself on her control over food. Bulimics knew they had an eating disorder and were repulsed and frightened by their behavior, while the anorexic denied it. Most bulimics were either normal weight or overweight compared with the emaciated anorexics. Left untreated, the disease caused vitamin deficiency and serious physical ailments such as liver, kidney, and heart disease. Hair loss occurred. Repeated vomiting could rupture the stomach, and the acid in the vomit eroded tooth enamel. About 40 percent of women with bulimia developed irregular menstruation, and, like anorexics, about 20 percent entirely stopped having their periods.

Causes

Theories about these disorders included psychological, biological, and social explanations. Psychological explanations for anorexia focused on the fear of maturing and the fear of loss of control. Bulimia was regarded as a fear of food that created a compulsion, which led to stress and fear around episodes of binge eating and purging. Scientists also thought the disorders might be associated with a disorder of the hypothalamus, which produces hormones and regulates hunger, thirst, and temperature. Since some bulimics improved after treatment with antidepressant drugs, other biological theories linked it to decreased serotonin activity in the brain. Social scientists blamed social pressures. Women were constantly bombarded with advertisements and un-realistic role models suggesting that women's only worth was in their youth and their slim appearances. A Glamour magazine survey in 1984 revealed that even 45 percent of underweight respondents thought they were too fat and needed to lose weight. Although the response was not reflective of the population as a whole, the survey revealed a striking number of women who considered themselves overweight even though they were normal or underweight.

Treatment

Hospitalization and lifesaving measures were the first course of treatment for anorexia, with psychotherapy following as soon as the patient was stabilized. Residential treatment facilities for anorexics were developed during the 1980s that included family therapy, behavior modification, and counseling. Between 15 percent and 25 percent of anorexics relapsed occasionally; and another 15 percent to 20 percent continued to be anorexic. Ten to 20 percent died from self-starvation. Bulimics could be successfully treated outside the hospital since their disorder was not so life threatening. Treatment usually consisted of therapy and antidepressant drugs, but a high rate of treatment failure was reported. As celebrities such as Jane Fonda and Cherry Boone O'Neill, the daughter of singer Pat Boone, publicly admitted their struggles with these eating disorders, other Americans continued their obsession with food and dieting. Almost any diet cookbook could appear rapidly on the best-seller list, but the diseases anorexia and bulimia were still poorly understood, and the treatments for them were far from universally successful.