Could my attitudes or behaviors be unhealthy or dangerous?
Eating disorders can lead to medical complications and emotional distress. Health problems caused by eating disorders stem from unhealthy weight loss or gain, poor nutrition, purging behaviors (vomiting, misusing laxatives or diuretics), diet pills, or excessive exercise.

Some of these medical problems can be quite serious. Indeed, the mortality rate for individuals with anorexia nervosa is 12 times higher than that of the general population. Below are descriptions of the major medical problems.

Anorexia nervosa can cause low blood pressure, slow pulse, or low body temperature. It may also stimulate growth of fine white hair (lanugo) on the body. In addition, some individuals with anorexia develop abnormalities in their blood count (such as anemia) and in their blood chemistry. Both anorexia and low weight open the door to menstrual irregularities and sometimes to infertility. Failure to menstruate sets the stage for serious thinning of the bones (osteoporosis), which may become permanent. Some teenagers with anorexia stop developing or growing normally, resulting in a shorter stature. Extremely low weights can lead to failure of vital organs and, sometimes, to death.

A variety of serious health problems derive from the purging behaviors associated with bulimia nervosa. Chronic vomiting can cause bleeding in the throat and (very rarely) rupture of the esophagus. Use of syrup of ipecac is extremely dangerous and may subject the nervous system or the heart to major damage.

Abuse of laxatives (meaning frequent use of laxatives to purge calories or get rid of a feeling of fullness) potentiates many kinds of bowel (intestinal) problems, some of which require surgery to correct. Vomiting, laxative use, or diuretic use over a period of time increase the risk of hypokalemia, in which the body loses too much potassium. This condition can precipitate severe disturbances in the heart's rhythm and can even cause the heart to stop.

Diet pill use may also lead to heart rhythm disturbance and to changes in pulse and blood pressure. In addition, diet pills can interact with a group of antidepressant medications (monoamine oxidase inhibitors, or MAOIs) to generate serious side effects.

Finally, exercise - while healthful in moderation for otherwise healthy individuals - tends to become excessive, paving the way for menstrual cycle abnormalities and stress fractures.

Binge eating (eating an unusual amount of food in a certain period of time while feeling the eating is out of control) often results in obesity, which is associated with high blood pressure, diabetes, high cholesterol, heart disease, arthritis, and some cancers.

Whether or not eating disordered behaviors have significant health consequences depends on the severity, frequency, and duration of symptoms and also on an individual's baseline health. Any weight abnormalities or purging behaviors should be discussed with a doctor to determine the best way to prevent serious health consequences and address any that have occurred.

  
Do I need to see a doctor?
Anyone who has been diagnosed with an eating disorder or who has disordered eating behaviors needs to be evaluated and monitored by a physician. In addition to ordering laboratory tests (such as blood counts and blood chemistries), the doctor will check for any medical consequences of disordered eating as well as monitor weight loss or gain, pulse, and blood pressure. Occasionally, doctors will run an electrocardiogram for heart function or refer the person for bone densitometry to determine whether her bones have thinned.

Treatment for an eating disorder ideally includes a mental health professional as well as a primary care physician. Many people with disordered eating are afraid that their doctors will be shocked by or will not understand their symptoms; these individuals avoid telling their doctors. It is important for you to feel comfortable confiding in your physician about any eating or weight problems, symptoms, or concerns you may be experiencing.

If you are avoiding disclosing your symptoms and concerns to your doctor, you may need to come up with a new plan, such as finding a health care professional you feel is more approachable. It also can help to write a letter to your doctor describing your symptoms or to enlist the support of a friend or family member to help you discuss this with your doctor.

  
Do I need to see a counselor? Eating disorders are serious illnesses requiring treatment. The symptoms do not generally go away without professional care. Since some kind of emotional distress is usually at the root of an eating disorder, counseling (or psychotherapy) is usually necessary to treat the problem. Psychotherapy can help a patient address the reasons that eating behaviors and/or body or weight preoccupation have become out of control. Certain psychotherapies focus on teaching individuals how to stop their unhealthy behaviors and on understanding and changing the negative feelings that patients with eating disorders often experience about themselves and their bodies. A counselor will also be able to determine whether there might be some additional problem - such as depression or anxiety - that is possibly making the eating disorder worse.

  
What is the treatment for an eating disorder?
For most people, eating disorders can be treated successfully with a combination of ongoing medical care and monitoring, psychotherapy, nutritional counseling, and often, medication. Medical monitoring helps to correct and prevent some of the potentially dangerous complications of eating disorders, such as bone density loss or disturbances in the heart's rhythm.

Psychotherapy offers strategies aimed at recognizing and changing behaviors associated with eating disorders. It can also identify and address the psychological stressors in interpersonal and family relationships, major losses, and traumatic events that may have contributed to the development of an eating disorder. Nutritional counseling assists with formulating a reasonable, tolerable plan for eating and supports following it consistently.

Finally, several different kinds of medications have been useful in readjusting the brain chemistry that may be in part responsible for the eating disorder. Newer types of antidepressants, such as SSRIs (selective serotonin re-uptake inhibitors) can help relieve eating disorder symptoms and have few side effects.

  
Can medication help an eating disorder?
Although generally more useful in the treatment of bulimia or binge eating disorder than anorexia, many medications can safely help to eliminate or diminish symptoms associated with eating disorders and may be prescribed in conjunction with psychotherapy. Antidepressants are the drugs most commonly used to treat anorexia and bulimia.

Studies have found that bulimia is more successfully treated with medication than anorexia. While the older types of antidepressant medications have worked well for treatment of these disorders, the newer type, called selective serotonin reuptake inhibitors, has been especially effective. These medications not only treat underlying mood symptoms that often accompany eating disorders, but may suppress the craving to binge and purge that is experienced in bulimia.

Antidepressants take several weeks to be effective, so if you take them, you will not see results immediately. Sometimes individuals will not respond to or tolerate one type of antidepressant, yet will do very well on another. For this reason, several types of medications and dosages may be tried before an effective one is found.

Antidepressants are not habit-forming, though they can cause some side effects, including dry mouth, blurred vision, light-headedness, constipation or diarrhea, urinary retention, changes in sexual interest or function, headache, weight gain or appetite suppression, and drowsiness or wakefulness. It is important to note that many people are not bothered at all by side effects of their medication. Since different medications have different side effect profiles in different people, your doctor will work with you to find the most effective medication that you find acceptable.

Before prescribing any medication, your doctor will talk to you about coexisting medical problems and review the medications you are currently taking; this assessment process will help ensure the proper choice of medication and dosage, avoid exacerbation of an existing health issue, and minimize negative interactions with other medications.

  
What kinds of counseling or therapy can help an eating disorder?
There are many types of psychotherapy (talking therapy). The three most common types are cognitive behavioral therapy, interpersonal therapy, and psychodynamic psychotherapy. They can take place in individual, group, or family sessions. Family therapy is likely to be the most effective treatment for adolescents with anorexia and may also be a useful adjunctive therapy for adolescents with bulimia.

Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is based on the premise that a person suffering from an eating disorder has errors in thinking and perceptions that result in unrealistic attitudes about herself and unhealthy behaviors. In CBT, a person learns and practices new ways of thinking, self-monitors behaviors and attitudes, resumes normal behaviors at a modest pace, and learns new coping strategies. CBT is generally short term, highly structured, and goal oriented.

Dialectical Behaviorial Therapy
Many individuals with eating disorders are extremely self-critical. Through dialectical behavior therapy (DBT), they can learn to experience and value their emotions and, at the same time, try to modify unhealthy behavior patterns. DBT teaches paients to practice mindfulness - to become aware of their feelings, to stay in the moment, and to develop a nonjudgmental outlook on themselves and others. Self-defeating behaviors are gradually replaced with positive, healthy coping skills.

Psychodynamic Psychotherapy
Psychodynamic psychotherapy is generally a more lengthy therapy than the other two. It centers on the idea that unresolved conflicts or painful experiences in an individual's childhood persist into adulthood, creating problems in that individual's personal life. The theory behind this therapy is that understanding and resolving childhood conflicts frees the individual from repeating behavioral patterns, thus allowing her to meet life's demands and stresses more successfully.

Another kind of therapy is a self-help, or support group. Support groups provide the opportunity for individuals with eating disorders and their families to gain emotional support, learn about eating disorders, and access the mental health system. Such groups offer patients a chance to interact with people who have successfully overcome eating disorders.

The Maudsley Treatment Model
Named for its place of origin - the Maudsley Hospital in London - this is a particular kind of prescribed outpatient family therapy that has shown promise for adolescents with anorexia nervosa or bulimia nervosa. The Maudsley approach gives parents an active role in their teenager's care under the guidance of a psychotherapist. The eating disordered adolescent, her parents, her siblings - and, in fact, everyone in her household - generally participate in family therapy sessions. Maudsley treatment consists of 3 phases. The first phase helps parents take charge of their adolescent's eating in a supportive yet firm manner. Brothers and sisters are asked to be encouraging and positive toward the eating disordered member as she struggles to follow her parent-directed nutrition program. When the patient's nutritional health has improved under parental supervision, she is ready for Phase 2, in which she assumes increasing responsibility for her eating. In the third phase of treatment, therapy addresses trials and tribulations of adolescence (such as autonomy and interpersonal relationships) that are not related to eating.

  
Will I get better?
As treatment begins to take effect, whether with psychotherapy, medication, or a combination of both, eating disorder symptoms begin to diminish. People in treatment begin to feel better and function more efficiently.

In most cases, early intervention increases the likelihood of favorable results for those suffering from eating disorders. Most patients respond positively to treatment. Although we know there is a possibility of recurrence of symptoms, early detection and treatment do make a difference.