Could my attitudes or behaviors be unhealthy or dangerous?
Eating disorders can lead to medical problems and emotional distress. Health problems caused by eating disorders are created by unhealthy weight loss or gain, poor nutrition, or purging behaviors, such as vomiting, laxative use, diuretic (water-pill) use, diet-pill use, or excessive exercise.

Some of these medical problems can be quite serious. Indeed, anorexic women have a death rate 12 times higher than women without anorexia nervosa. Some of the more important problems are described below, but this is by no means an exhaustive list.

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

Purging behaviors associated with bulimia nervosa can lead to a variety of serious health problems. Chronic vomiting can lead to bleeding in the throat and (very rarely) to rupture of the esophagus. Use of syrup of ipecac is extremely dangerous and can lead to major damage to the nervous system or to the heart.

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

Diet pill use can also lead to heart rhythm disturbance and changes in pulse and blood pressure. Diet pills can also interact with some antidepressant medication (monoamine oxidase inhibitors, or MAOIs) to cause serious side effects.

Finally, exercise - while healthful in moderation for otherwise healthy individuals - can become excessive and lead to 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) can lead to 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 should be evaluated and monitored by a doctor. A doctor should check for any medical consequences of weight or disordered eating as well as monitor weight loss or gain, pulse, and blood pressure. The doctor should also check blood for low potassium and laboratory abnormalities. Occasionally, doctors will want to check an electrocardiogram for heart function or refer the person for a bone densitometry to determine whether her bones have thinned.

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

If you find that you are avoiding telling your doctor about your symptoms or concerns, you may need to take a new approach, such as finding a new 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 help. 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 an individual address the reasons that eating behaviors and/or body or weight preoccupation have become out of control. Certain psychotherapies help to teach individuals how to stop their behaviors and to understand and change the negative feelings that individuals with eating disorders often have 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 led to development of an eating disorder. Nutritional counseling assists with developing a reasonable, tolerable plan for eating and supports following it consistently.

Finally, several different kinds of medications can be helpful in readjusting the brain chemistry that may be in part responsible for the eating disorder. Newer types of antidepressants have become safer, have fewer side effects, and can help bring relief from eating disorder symptoms.

  
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 most commonly used drugs used to treat anorexia nervosa and bulimia.

Studies have found that bulimia is more successfully treated with medication than anorexia nervosa. While the older types of antidepressant medications have worked well for treatment of these disorders, the newer type, called selective serotonin reuptake inhibitors, have been especially effective. These medications not only treat underlying mood symptoms that may be associated with 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 any medication is prescribed, your physician will discuss any coexisting medical problems and review current medications being taken in order to insure proper choice and dosage of medication and to avoid exacerbation of an existing health problem 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 may 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 or himself, which lead to 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.

Interpersonal Therapy
Interpersonal therapy (IPT) is based on the premise that eating disorders result from troublesome interactions with significant others. Generally short-term, IPT focuses on current social functioning with important people in a person's life. Behavior patterns are observed, feelings are clarified, and alternative behaviors are explored, primarily centering on the individual's present situation.

Psychodynamic Psychotherapy
Psychodynamic psychotherapy is generally a more lengthy therapy than the other two. It focuses 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 helping the individual meet life's demands and stresses more successfully.

Another kind of therapy is a self-help, or support group. Support groups offer 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 the 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 teen-ager's care under the guidance of a psychotherapist. The affected 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, responsibility for her eating is returned to her (Phase 2). 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 positive 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 intervention and treatment do make a difference.