Why do eating disorders (bulimia nervosa and anorexia nervosa) require medical attention?

Anorexia may be a single, limited episode with large weight loss within a few months followed by recovery. Or it may develop gradually and persist for years. The illness may go back and forth between getting better and getting worse. Or it may steadily get more severe.

Anorectics may exercise excessively. Their preoccupation with food usually prompts habits such as moving food about on the plate and cutting it into tiny pieces to prolong eating, and not eating with the family.

Obsessed with weight loss and fear of becoming fat, anorectics see normal folds of flesh as "fat" that must be eliminated. When the normal fat padding is lost, sitting or lying down brings discomfort not rest, making sleep difficult. As the disorder continues, victims may become isolated and withdraw from friends and family.

The body responds to starvation by slowing or stopping certain bodily processes. Blood pressure falls, breathing rate slows, menstruation ceases (or, in girls in their early teens, never begins), and activity of the thyroid gland (which regulates growth) diminishes. Skin becomes dry, and hair and nails become brittle. Lightheadedness, cold intolerance, constipation, and joint swelling are other symptoms. Reduced fat causes the body temperature to fall. Soft hair called lanugo forms on the skin for warmth. Body chemicals may get so imbalanced that heart failure occurs.

Anorectics who additionally binge and purge impair their health even further. The late recording artist Karen Carpenter, an anorectic who used syrup of ipecac to induce vomiting, died after buildup of the drug irreversibly damaged her heart.

Getting Help

Early treatment is vital. As either disorder becomes more entrenched, its damage becomes less reversible.

Usually, the family is asked to help in the treatment, which may include psychotherapy, nutrition counseling, behavior modification, and self-help groups. Therapy often lasts a year or more--on an outpatient basis unless life-threatening physical symptoms or severe psychological problems require hospitalization. If there is deterioration or no response to therapy, the patient (or parent or other advocate) may want to talk to the health professional about the plan of treatment.

There are no drugs approved specifically for bulimia or anorexia, but several, including some antidepressants, are being investigated for this use.

If you think a friend or family member has bulimia or anorexia, point out in a caring, nonjudgmental way the behavior you have observed and encourage the person to get medical help. If you think you have bulimia or anorexia, remember that you are not alone and that this is a health problem that requires professional help. As a first step, talk to your parents, family doctor, religious counselor, or school counselor or nurse.