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	Eating Disorders
	Definition
	There are two major forms of eating disorder, anorexia nervosa (severe self-starvation) and bulimia (binge eating and purging). The prevalence of these conditions has increased dramatically in recent decades. (Both conditions occur much more frequently in girls). Anorexia nervosa affects 1 in 100 to 200 girls between ages 12 and 18. The problem begins when a girl is unhappy with her appearance and starts dieting. She may say she feels fat and continue to diet, when she is in fact underweight. Almost all teenage girls diet at one time, but most do not develop anorexia nervosa. When a girl becomes profoundly underweight, physical symptoms may develop, including sensitivity to cold, constipation, weakness, leg swelling, and growth of fine body hair. Menstruation may cease after more weight loss. Most symptoms disappear when weight returns to normal. There is a risk of death in 5 to 18 percent of people with anorexia nervosa. Peculiar behaviours may develop as a result of starvation, perhaps because people with anorexia nervosa still feel hungry. For example, an anorexic may prepare elaborate meals for others and not eat them herself, or she may collect recipes. Anxiety begins to surround any situation where food is present while the anorexic denies that there is a problem. Bulimia starts in late adolescence and can continue to the mid-30s. At one time it was estimated that 5 to 10 percent of women in college suffered from bulimia. A person with bulimia eats large amounts of high-calorie foods secretly and then vomits, exercises to excess, or takes laxatives and diuretics to keep weight down. Someone suffering from bulimia lives in fear of gaining weight. Despite bingeing and purging, most bulimics are of normal weight, making this disease very difficult to recognize. In rare cases bulimia can cause death from electrolyte imbalances and dehydration. More commonly, laxatives and vomiting can cause dental problems, constipation, and rupture of the esophagus. Peculiar behaviours may also develop to enable the person with bulimia to obtain a large amount of food, for example, hoarding or stealing food.
	Cause
	Anorexia nervosa is more common in women with low self-esteem, family members with the disease, and depression. Less commonly, it develops in young dancers or athletes, such as gymnasts or runners whose coaches stress slimness. The problem usually begins at a time when a girl becomes concerned about emerging sexuality and bodily changes. She becomes convinced that she is too fat and restricts her eating, sometimes to emaciation. There is also sometimes a power struggle that develops in the home, which may be a reflection of difficulty with separation from parents. Factors that produce bulimia are often similar to those for self-starvation. Obesity in adolescence may also predispose to this disorder.
	Diagnosis
	Criteria for diagnosing anorexia nervosa, include: Refusal to maintain body weight over a minimal normal weight for age and height, for example, 15 percent below expected; or failure to make expected weight gain during period of growth. Intense fear of gaining weight or becoming fat, even though underweight. Disturbance in the way a person sees her body weight, size, or shape, for example, the person claims to feel fat even when emaciated. In females, absence of at least three consecutive menstrual cycles when there is no other explanation. Criteria for diagnosing bulimia nervosa, include: Recurrent episodes of binge eating (rapid consumption of food in a discrete period of time). A feeling of lack of control over eating behavior during the eating binges. Regularly engaging in either self-induced vomiting, use of laxatives or diuretics, strict dieting or fasting, or vigorous exercise in order to prevent weight gain. A minimum average of two binge-eating episodes a week for at least 3 months. Persistent overconcern with body shape and weight.
	Treatment
	Women with anorexia nervosa can be very difficult to treat because of the large component of denial about their weight loss and body size. Ideally, treatment should be sought when the first signs of self-starvation appear and before weight loss has become dramatic or dangerous. The starvation state itself may cloud the anorexic's ability to understand what is happening or participate in therapy. The longer the disorder goes untreated, the more likely it is to become chronic. Parents should discuss concerns about abnormal eating behaviour, even before significant weight loss, with a physician. The first step in treatment is weight gain, as it is difficult to deal with emotional problems while weight is dangerously low. Hospitalization is required when low weight is dangerous at about 25 percent below the person's normal weight. Individual psychotherapy is essential for successful treatment and resolution of the underlying issues. Family psychotherapy and family support groups may also be needed. Some suggestions for the family are: do not feel guilty, do not give excess sympathy, do not make food an issue, be open and communicative, and maintain family normalcy. Treatment for bulimia differs in that the focus is on altering the eating behaviour. People with bulimia should keep a record of their binges and learn to recognize situations that make them vulnerable, such as stress, loneliness, or hunger. They should learn to develop methods to deal with the situations, such as exercise, work, or calling a support person. Once the behaviour is resolved, individual or group psychotherapy and consultations with a support group for people with eating disorders can be beneficial.
	Home Remedies and Alternative Therapies
	Exercise from early adolescence may be beneficial in preventing these disorders if done in moderation. Keeping a fit and strong body at any age may improve self-esteem and prevent the cycle of yo-yo dieting that can lead to food cravings and excessive weight loss.
	Male/Female Differences
	Anorexia occurs 20 times more commonly in women than men and bulimia occurs 10 times more commonly in women than men.