Eating Disturbances - What's What?

Breaking Out of Food Jail: How to Free Yourself from Diets and Problem Eating, Once and for All
by Jean Antonello, R.N., B.S.N.

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Along with the traditional definitions of the best-known eating disorders, anorexia and bulimia, we'll discuss some popular descriptive labels: bulimarexia, compulsive undereating, compulsive overeating (including emotional overeating), food addiction and the new, broader term "eating disturbance."

Anorexia Nervosa

"Anorexia" simply means "without appetite," and "nervosa" means "mental in origin." This lack of appetite is the hallmark of anorexia, but it is a bit misleading. Although it appears that anorectics do not experience hunger because they eat so little, most do get hungry and at times their hunger is so extreme that it frightens them. Although anorectics experience mental symptoms, I believe these symptoms do not cause anorexia. Instead, they usually result from self-starvation.

Here's a checklist of the symptoms usually associated with anorexia. Check any symptom that applies to you.

Symptoms of Anorexia Nervosa

• Self-starvation, chronic undereating
• Obsession with being thin
• Refusal to maintain body weight within normal limits
• Weight loss 15 percent or more below normal limits
• Failure to gain weight appropriate for body growth
• Intense fear of gaining weight or becoming fat
• Body-image disturbance; a claim to feeling fat even though underweight or emaciated
• Absence of three consecutive menstrual cycles (without other cause)
• Abuse of laxatives and diuretics to control weight
• Purging of food by excessive exercise or self-induced vomiting — after eating

Marianne became concerned about her eating when she was just twelve. About a year after she started to develop breasts and hips, she saw a TV program about our country's high-fat diet and abruptly decided to go low-fat in her own eating. At first she continued to eat with her family, avoiding fatty foods, but after a while nothing her parents served was acceptably low-fat for her. She grew preoccupied with eating and food preparation. She developed strict rules and standards for food quality, gradually lowering the fat in her diet until it was absent. She started jogging. Her appetite became erratic. She skipped meals, sometimes going all day on a few rice cakes or crackers. She lost weight. At five feet and 105 pounds, Marianne was never big to begin with, but she liked feeling smaller because she felt more comfortable åround her slim girlfriends. This fueled her anti-eating and exercise efforts even more.

Marianne's parents began to argue with her, suggesting that she eat a little more and relax her strict rules. Eventually she wouldn't talk about her eating with anyone. She seemed locked in a world of her own determination. Eight months and twenty-two pounds later, Marianne seemed to have wandered into a hopeless pattern, beyond help. She insisted she was much too fat, but her bones were visible everywhere.

Anorectics, like many other people with eating disturbances, are usually "experts" on nutrition, capable of listing the calorie and fat contents of dozens and sometimes hundreds of foods. They talk, think, read and worry about food; and hoard it. Their world revolves around the topics of food and eating while they carefully and persistently avoid taking any substantial nourishment into their bodies. They may even prepare elaborate meals for others, spending hours at the grocery store and in the kitchen, but then refuse even to taste their culinary creations. It is the intensity of theiir fear of weight gain, coupled with their success at avoiding food, that sets anorectics apart from those suffering from other eating struggles.

Bulimia

"Bulimia" means "a constant and insatiable craving for food." This extreme sensation of hunger causes anxiety and even panic for those who are fearful of becoming overweight because they know that satisfaction of this morbid hunger will lead to weight gain. Loss of control over their appetites triggers bulimic bingeing, and panic about gaining weight prompts purging. Many popular medical reference books refer to bulimia as an emotional disorder, but I haven't found that theory valid in my work.

Here's the symptoms checklist for bulimia or compulsive overeating. Check each symptom that applies to you.

Symptoms of Bulimia

• Strict dieting or fasting to control weight

• Recurrent episodes of binge eating (consuming large amounts of food in a short time)

• A loss of control over eating behavior

• Self-induced vomiting, use of laxatives or diuretics, vigorous exercise and/or use of amphetamines to control weight

• Preoccupation with diet, weight and body image

• Distorted body image

Like anorexia, the number-one symptom of bulimia is undereating —eating significantly less food than you need. Bulimics are just as afraid of being fat as anorectics, but they are less successful at staying away from food. They are determined to control their eating by strict food avoidance and often develop elaborate rules and systems, just like anorectics, but they lose control of their eating in spite of their determination and because of their misguided efforts. Compulsive overeaters have all the symptoms of bulimia, except they may not purge.

Bulimics may be underweight, overweight or of normal weight. Many bulimics have been anorectic, and vice versa.

Bulimarexia

This self-descriptive term is relatively new. One definition for "bulimarexia" is "a psychological disorder in which a person alternates between an abnormal craving for food and an aversion to it, found especially among young women." In my experience, this condition is always accompanied by strict dieting, food phobia and avoidance, and obsession with food and eating. It's really no more "psychological" than dieting! This term is often used interchangeably with anorexia or bulimia. More on bulimarexia at the end of this chapter.

The Common Denominator in Eating Disorders — Dieting

I have never met an overeater who wasn't also an undereater — eating less food than she needs at times. I have never met an undereater who wasn't afraid of food because of traditional diet propaganda: that eating less and food avoidance are the keys to weight control. Every eating disturbance that I have encountered in more than five hundred clients started with dieting. And I have observed that most typical dieters suffer from at least some symptoms of bulimia.

Linda began her dieting efforts rather innocently after her first baby was born. Just two weeks postpartum, she was still about thirty pounds overweight and fearful of never losing it, like her mother. So Linda joined Weight Watchers and enjoyed her early success — a ten-pound loss in just three weeks. This is easier than I thought it would be, she reflected. But two weeks later Linda found herself raiding the refrigerator in the middle of the night — Swiss cheese and mayonnaise and chips and ice cream. This raid happened nearly every night, although Linda had never been a nocturnal eater before. In spite of these binges, she lost twelve pounds. When she plateaued, she cut down even more on her meal portions. She tried skipping her snacks, drinking diet pop instead. But her weight wouldn't budge. "You must be cheating," her counselor accused her. She was cheating. She was eating less than she was supposed to be.

One meeting day about three months into her very hungry diet, Linda "weighed in" and the scale showed a two-pound gain. That did it. After the meeting she went straight to the bakery across the street and bought a dozen huge caramel sweet rolls that were full of pecans. Linda sat in her car and began to eat the pastries, one after another, in rapid succession. She ate every last one and felt like a giant caramel roll herself. She caught a glimpse of herself in the mirror with her cheeks stuffed to capacity and the caramel dripping down her chin. This is one of those binges, she thought. I'm becoming an emotional overeater. I got so upset about the weight gain that I stuffed myself.

Embarrassed to return to Weight Watchers, Linda decided to try cutting down on her own. She found staying away from food altogether even easier in some ways than controlled eating. So most of the day she just skipped any serious food and sipped low-or no-calorie drinks. The only problem was in the evening. Her hunger seemed to get the best of her then, and she often lost control of her appetite, overeating the worst foods possible: chips, dips, ice cream, cookies and peanut butter. Now and then Linda would eat an entire pan of brownies or fudge, driven by a compulsive urge that she didn't understand. As her weight increased gradually, Linda's efforts doubled and she began a round of local diet programs. It didn't matter what program she tried, sooner or later the bingeing would creep back in. She simply could not control it indefinitely. Finally, out of desperation, Linda joined Overeaters Anonymous, where she learned that she was "addicted to food."

With researchers and "experts" leading the way, we have developed some superficially logical psychological theories to explain bizarre eating patterns. Although anorexia and bulimia seem to be very mysterious and complicated (as psycho-emotional problems can be), and have historically been classified as mental disorders, I will explore a simpler formula behind the development of these disorders: a desire to be thin that leads to undereating that leads to eating disturbances. It is this simple equation that links all these sick eating patterns together and promises to shed new light on their common physical cause.

Copyright © 1995 by Jean Antonello

About the Author

Jean Antonello, R.N., B.S.N., an obesity, eating disorders, and co-dependence specialist, is the director of the Naturally Thin Training Center in St. Paul, Minnesota, and is the author of How to Become Naturally Thin by Eating More. She lives in St. Paul.