3.7: Anorexia and Bulimia
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\(\newcommand{\avec}{\mathbf a}\) \(\newcommand{\bvec}{\mathbf b}\) \(\newcommand{\cvec}{\mathbf c}\) \(\newcommand{\dvec}{\mathbf d}\) \(\newcommand{\dtil}{\widetilde{\mathbf d}}\) \(\newcommand{\evec}{\mathbf e}\) \(\newcommand{\fvec}{\mathbf f}\) \(\newcommand{\nvec}{\mathbf n}\) \(\newcommand{\pvec}{\mathbf p}\) \(\newcommand{\qvec}{\mathbf q}\) \(\newcommand{\svec}{\mathbf s}\) \(\newcommand{\tvec}{\mathbf t}\) \(\newcommand{\uvec}{\mathbf u}\) \(\newcommand{\vvec}{\mathbf v}\) \(\newcommand{\wvec}{\mathbf w}\) \(\newcommand{\xvec}{\mathbf x}\) \(\newcommand{\yvec}{\mathbf y}\) \(\newcommand{\zvec}{\mathbf z}\) \(\newcommand{\rvec}{\mathbf r}\) \(\newcommand{\mvec}{\mathbf m}\) \(\newcommand{\zerovec}{\mathbf 0}\) \(\newcommand{\onevec}{\mathbf 1}\) \(\newcommand{\real}{\mathbb R}\) \(\newcommand{\twovec}[2]{\left[\begin{array}{r}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\ctwovec}[2]{\left[\begin{array}{c}#1 \\ #2 \end{array}\right]}\) \(\newcommand{\threevec}[3]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\cthreevec}[3]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \end{array}\right]}\) \(\newcommand{\fourvec}[4]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\cfourvec}[4]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \end{array}\right]}\) \(\newcommand{\fivevec}[5]{\left[\begin{array}{r}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\cfivevec}[5]{\left[\begin{array}{c}#1 \\ #2 \\ #3 \\ #4 \\ #5 \\ \end{array}\right]}\) \(\newcommand{\mattwo}[4]{\left[\begin{array}{rr}#1 \amp #2 \\ #3 \amp #4 \\ \end{array}\right]}\) \(\newcommand{\laspan}[1]{\text{Span}\{#1\}}\) \(\newcommand{\bcal}{\cal B}\) \(\newcommand{\ccal}{\cal C}\) \(\newcommand{\scal}{\cal S}\) \(\newcommand{\wcal}{\cal W}\) \(\newcommand{\ecal}{\cal E}\) \(\newcommand{\coords}[2]{\left\{#1\right\}_{#2}}\) \(\newcommand{\gray}[1]{\color{gray}{#1}}\) \(\newcommand{\lgray}[1]{\color{lightgray}{#1}}\) \(\newcommand{\rank}{\operatorname{rank}}\) \(\newcommand{\row}{\text{Row}}\) \(\newcommand{\col}{\text{Col}}\) \(\renewcommand{\row}{\text{Row}}\) \(\newcommand{\nul}{\text{Nul}}\) \(\newcommand{\var}{\text{Var}}\) \(\newcommand{\corr}{\text{corr}}\) \(\newcommand{\len}[1]{\left|#1\right|}\) \(\newcommand{\bbar}{\overline{\bvec}}\) \(\newcommand{\bhat}{\widehat{\bvec}}\) \(\newcommand{\bperp}{\bvec^\perp}\) \(\newcommand{\xhat}{\widehat{\xvec}}\) \(\newcommand{\vhat}{\widehat{\vvec}}\) \(\newcommand{\uhat}{\widehat{\uvec}}\) \(\newcommand{\what}{\widehat{\wvec}}\) \(\newcommand{\Sighat}{\widehat{\Sigma}}\) \(\newcommand{\lt}{<}\) \(\newcommand{\gt}{>}\) \(\newcommand{\amp}{&}\) \(\definecolor{fillinmathshade}{gray}{0.9}\)People with anorexia nervosa (often simply called anorexia) and bulimia take extreme measures to control their weight (see Personal Story of Anorexia at the end of this chapter). Their eating disorders have their basis in a pathological fear of being fat. In this sense, they are emotional disorders. Anorexia means without desire, and refers to a lack of appetite for food. Nervosa refers to its being a “nervous” (emotional) condition. Bulimia literally means to eat like an ox.
In contrast to anorexics (people with anorexia), bulimics go on eating binges, consuming huge amounts of food at one sitting. Anorexia and bulimia have their own distinctive characteristics (see Table 3-4), but some people exhibit some of the symptoms of both. Sometimes the disorders are referred to together: bulimarexia or bulimia nervosa. Both disorders are most common among young upper-middle-class white women (but occur in men and other social and ethnic groups as well). Strong social pressures in this group to be slim are undoubtedly contributing factors, but the exact causes of these disorders aren’t known.
Anorexics falsely see themselves as fat, even when they’re emaciated to the point of near starvation. Typically, they refuse to eat much, and they exercise compulsively—a sure recipe for weight loss. As a result, they typically are 20 to 40% underweight. Many anorexics have to be hospitalized and fed intravenously to keep them from starving themselves to death.
In contrast, bulimics tend to be of normal weight. They maintain their weight by following their bingeing episodes (gorging themselves with thousands of calories worth of food—usually “junk food”—at one sitting) with induced vomiting, and often laxatives and diuretics as well (see Fig. 3-4). The bingeing-purging is almost always done in secret, and frequently goes undiagnosed.
The dentist is often the first to diagnose bulimia, because of the otherwise unexplained appearance of demineralized enamel. The repeated vomiting brings stomach acid into contact with the enamel of the teeth, causing it to dissolve.
The medical problem of most concern is the regular large losses of electrolytes, such as chloride through the vomit (stomach acid is hydrochloric acid), and potassium from the use of certain diuretics. This can disrupt the beating of the heart which can, of course, be fatal.
The “gag me with a spoon” line in the song Valley Girls refers to the self‑induced vomiting of bulimia. Actress Jane Fonda and singer Elton John had bulimia; it caused singer Karen Carpenter’s death.
Clearly, anorexia and bulimia can have dire consequences and should be diagnosed and treated as early as possible. Treatment should be a team effort, including family members and health professionals such as physicians, psychologists, and dietitians.