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Anorexia nervosa is a psychological illness with often devastating physical consequences. The sufferer usually has a morbid fear of weight gain and becoming fat, although this is not the case for all anorectics. Those suffering from anorexia will deprive themselves of food (and sometimes liquids), leading to weight loss and, usually, a variety of physical problems and health issues.

Like other eating disorders, anorexia is a mask covering other underlying problems. The sufferer tends to have low self-esteem and a need to control aspects of their environment. Anorexia is used as a way to cope with stress anxiety and feeling out of control.

Eating disorders, particularly anorexia and bulimia, usually affect females but the number of male anorectics is on the increase. Somebody can develop anorexia at any age, in any place and in any situation.

Diagnostic criteria (DSM IV)

Refusal to maintain body weight over a minimum normal weight for age and height (i.e. weight loss leading to body weight 15% below that expected… or… failure to make expected weight gain during a period of growth, leading to a body weight 15% below that expected.)
Intense fear of gaining weight or becoming fat even though underweight.
Disturbance in the way in which one’s body weight, size or shape is experienced, undue influence of body shape and weight on self-evaluation, or denial of the seriousness of low body weight.
In females, absence of at least three consecutive menstrual cycles when otherwise expected to occur (primary or secondary amenorrhea).

Physical signs and symptoms

There are many physical symptoms associated with anorexia, some of which become more
severe the longer the disorder remains untreated. Most sufferers will encounter health
problems sooner rather than later. These problems include:
● Starvation
● Dehydration
● Muscle and cartilage deterioration
● Osteoporosis
● Irregular or slow heart beat
● Heart failure

There are two divergent groups of brain imaging folks who believe dopamine [the “feel good” neurotransmitter] plays a role in disrupting the experience of hunger and appetite with those who restrict. Basically there are two theories on the table today.

The first suggests over eating types of eating disorders involve dopamine serving as the “reward” and “feel good” chemical released in the brain when overeating. However, with the restricting forms of eating disorders such as anorexia, the experience of increased dopamine concentrations when eating is unpleasant. Hence, the feelings associated with eating are negative for someone with anorexia and rewarding for someone with compulsive overeating or bulimia.

Another group of scientists are looking into the effects of fasting or restricting on dopamine levels for anorexics – the idea being a similar surge of “feel good” dopamine ensues – but this time stimulated by restricting to the point of starving. In other words, there may be a phenomenon for some people to “feel rewarded” by severely restricting their calorie intake. Accordingly, the more one restricts, at least in the early stages of anorexia, the more dopamine is released, the more rewarded they feel, and the more reinforced restricting behavior becomes. No one knows why some are prone to this end of the eating disorder spectrum as opposed to the other. In sum, this hypothesis suggests that dopamine “rushes” affect anorexics and overeaters alike, but for one group starving releases the chemical and for the other binge eating does the trick.

Here is an excerpt from Walter H. Kaye, M.D., one of the researchers at the University of California, San Diego who is looking into the above theories. His comments also touch upon a possible explanation for the body image distortions inherent with anorexia.

“The reason (anorexics) can go on a diet and lose all the weight is that their brain is not responding in a way that is driving eating.” Whether it’s not responding to the sensory aspect, it’s not the right signal about food, it’s not rewarding, we don’t really understand, but there’s something different about these homeostatic mechanisms.”

“The area of the brain known as the insula, is important for appetite regulation and also for something called interceptive awareness, which is the ability to perceive signals from the body like touch, pain, and hunger. It’s possible that some of the problems anorexics have regarding body image distortion can be related to alterations of interceptive awareness. There may be some dysregulation of insula function. This may in part explain why a recovering anorexic can draw a self-portrait of their body image that is typically 3X its actual size.” To quote from someone with this experience who is now recovering from anorexia, “I was down to 80 pounds at five-foot six,” she says. “My self-portrait was so distorted I was able to lie down inside the drawing. But that’s how I saw myself.”

As to the issue of consequences or potential risks associated with Binge Eating, a recent article in Epidemiology and Psychiatric Sciences reveals binge eaters have up to a fourfold increase in being unable to perform “normal daily activities” – sometimes referred to as ADLs [activities of daily living]. These can include proper hygiene, preparing meals, gainful employment, and maintaining their living space. Although specific statistics are currently in the process of being compiled, it is evident the incidence of clinical depression, suicide, premature death, numerous chronic diseases such as diabetes and heart disease are significantly greater among those suffering with BED. Suffice it to say, BED has as great an impact on the quality of life as do its cousins, anorexia and bulimia.

In terms of incidence, in comparison to other eating disorders, the study found BED to be more than twice as common as Bulimia, not only in the United States, but in other countries included in the research such as Mexico, Italy, Portugal, Spain, and several other countries. I suspect the incidence of BED is also significantly higher in men in comparison to Bulimia as well.

The study source is the Harvard Medical School.
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She would buy 5-gallon buckets of vanilla and consume the entire container, drizzled in chocolate sauce in less than a week. Bowl after bowl, quart after quart, she felt powerless to stop herself from opening the freezer and digging in.

In January 2007, she saw the 247 pounds on her 5-foot-9 frame increase and was outgrowing her size 20 pants. At age 59, she could no longer keep up with her grandchildren and decided something needed to change.

“My name is Donna and I am a recovering compulsive overeater,” she said during an Overeaters Anonymous meeting last month at Westminster Church in downtown Sacramento.

The lunch-hour gathering is one of more than 50 meetings in the area that regularly bring people together to talk about their struggles and successes in managing food dependency.

Overeaters Anonymous is a self-directed, 12-step program that promotes well-being and helps individuals manage food obsession.

In the Sacramento region, an estimated 300 to 500 people regularly attend such meetings, read OA literature and work with sponsors to recover from a compulsive overeating.

“I was a five-time Weight Watchers registrant, and I just wasn’t a very good dieter,” said Donna, who like others interviewed asked to be identified by first name only in accordance with the group’s pledge of anonymity.

“(OA) isn’t a diet. It’s a process of learning how to live life without using food as a stress reliever, a problem solver.”

Donna attends two meetings a week. She said she has lost 61 pounds in her five years with OA.

Founded in Los Angeles in 1960, OA serves about 54,000 members in more than 80 countries.

Uncontrollable overconsumption is a symptom of binge-eating disorder, or BED, a condition that is gaining acceptance among medical professionals.

BED was first listed in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders in 1994. The manual, published by the American Psychiatric Organization, is the guide used for assessment of psychiatric illnesses.

Before that publication, the disorder was not formally identified, said Dr. Timothy Walsh, chairman of the psychiatric association’s Eating Disorders Workgroup for the upcoming fifth edition of the diagnostic manual. Recognition by medical professionals of the symptoms and potential treatments has increased over the past 20 years, with more than 1,000 articles published on the disorder, he added.

“People with binge-eating disorder compared with peers of a similar age and similar weight are more distressed and have more problems with mood and anxiety. They appear to require different types of intervention than do their peers,” Walsh said.

Like many OA members, Donna’s fight against food dependency is not isolated to overconsumption. She has a history of other dependencies.

Donna said she took on her father’s substance disorder and her mother’s anorexia by age 15.

By her mid-20s she was committed to an anorexia rehabilitation program, and said she has substance free by utilizing support groups for more than 27 years ago. But in the process to recover well-being, Donna compensated by overeating.

“I started relying on food to cure my anxiety,” she said. “It numbed me. It worked to relieve stress, and I began to eat in excess.” The numbers on the scale and her pants size increased in parallel until her sponsor helped her realize she had replaced, not gotten rid of, her dependencies.

The difference this time: She could not simply eliminate food. Donna said she has completely cut out foods that tempt her to overeat, including sugar and flour. “I don’t eat bread. I love bread and can eat a whole loaf,” she said. “I stopped eating some foods because I obviously can’t have a reasonable portion.”

Another person fighting the battle is Christian, 50. He has also suffered from both susbstance dependency and compulsive overeating. He works in downtown Sacramento and attends five to six meetings each week to control his eating habits.

With food the line is fuzzy,” said Christian. “You have to let the tiger out of the cage three times a day and get him back in the cage again.”

OA does not prescribe a specific diet or exercise regimen. Instead, the 12-step program helps members address the “physical, emotional and spiritual” levels of to help with food dependency recovery, according to the website. Members are in charge of defining their own abstinence because individuals have different needs.

For Christian, abstinence has firm lines. He has set a number of rules that help him evade triggers and manage consumption habits.

He removed “red-light foods” such as sugar from his diet and does not purchase “yellow-light foods” such as chips. He no longer eats in the car, while standing or when in bed.

Each weekday morning he emails a “food plan” to his OA sponsor that details his typical breakfast (a PowerBar, banana and coffee), lunch (a sandwich or soup) and dinner (a combination of two items from Trader Joe’s that total less than 750 calories). Planning ahead has helped him control his habits and lose 50 pounds in just over two years.

Like many OA members, Christian and Donna both said they are still recovering from their food dependency.

“It’s a lifelong struggle and a lifelong program,” Donna said, adding that she relapsed last spring after missing meetings with her sponsor.

While the 12 steps of OA are directed toward binge eating – the program also helps individuals with other eating disorders including anorexia and bulimia.

“Whether we are undereating or overeating, the fact is we are not dealing with life,” said Rick, chairman of the Sacramento Valley Intergroup of OA.

“Our goal is to give support to the compulsive overeaters who still suffer, and provide support for newcomers who need strength,” Cher said.

By Jacqueline Sahlberg

Published: Thursday, Jul. 26, 2012 – 12:00 am | Page 1D

Last Modified: Thursday, Jul. 26, 2012 – 11:47 am

“Strikingly, things are as bad in this age group as they are in the younger age groups. I was sort of gobsmacked that 8% reported purging in the last five years,” says researcher Cynthia M. Bulik, PhD, director of the University of North Carolina Eating Disorders Program, in Chapel Hill.

Additionally, Bulik says, 3.5% of women older than 50 reported binge eating within the last month, a percentage that is “spot on for the younger population.”

Sixty-two percent of the nearly 1,900 women who participated in the Internet-based survey said their weight or shape negatively impacted their life. “That’s really sad,” Bulik says.

Experts who were not involved in the research said the study is valuable because it supports earlier work suggesting that eating disorders are a problem across the lifespan.

“Very little work has been conducted to understand eating pathology in older women who may have unique needs in relation to developing and maintaining a healthy body image and healthy approach to weight regulation,” Pamela Keel, PhD, a professor and clinical psychologist who specializes in treating eating disorders at Florida State University in Tallahassee, says in an email to WebMD.

The study is published in the International Journal of Eating Disorders.

Many in Their 50s Are Battling Eating Disorders for the First Time

In some cases, women with eating disorders in mid-life have struggled with their weight and body image before and are relapsing after a period of recovery.

But in many cases, Bulik says, women are bingeing, purging, exercising for hours, or not eating enough for the first time in their lives.

“Part of that is ’70 is the new 50,’” she says. “We have to keep our body looking 20 years younger than it actually is, and that’s an enormous amount of pressure for these women. That’s what sort of puts them on this slippery slope. They see the distance between what’s happening to themselves, their body and the societal ideal, and then they start engaging in really unhealthy weight control practices,” Bulik says.

The average age of study participants was 59, and 92% were white.

About a third of women reported spending at least half their time in the last five years dieting.

Other weight control methods reported in the study included:

• Diet pills (7.5%)
• Excessive exercise (7%)
• Diuretics (2.5%)
• Laxatives (2%)
• Vomiting (1%)

What is Bulimia Nervosa?

Bulimia nervosa is a psychological illness characterized by the sufferer binging and then purging themselves of food. It is often related to both anorexia nervosa and binge-eating disorder.

However, the sufferer may not always have a morbid fear of weight gain and there are those who purge without binging, a condition that has been identified (but not officially diagnosed) recently as purging disorder.

There are many methods of purging, although self-induced vomiting is the most common. Other methods include laxative and diuretic abuse, over-exercise and periods of starvation, as a means of compensating for calories consumed.

Eating disorders, particularly anorexia and bulimia, usually affect females, but the number of male anorectics is on the increase. Somebody can develop anorexia at any age, in any place and in any situation.

According to A.N.R.E.D., approximately 4% of college-aged women in the United States are bulimic. However, Rader Programs puts this figure much higher at 19%. The reality may lay somewhere in between.

Approximately 5.1% of women in college in the United States suffer from bulimia.

Approximately 80% of bulimia nervosa patients are female (N.E.D.A.).

Eating disorders are bad news for teeth

Eating disorders affect around 15% of young girls to varying degrees, around five to ten times more than men. These illnesses involve a constant preoccupation with food, a distorted body image and excessive measures taken to control weight… excessive to the point of harming your body’s health, as well as, your mental health and interpersonal relations.

The most common eating disorders are anorexia nervosa (restriction of food intake) and bulimia (episodes of compulsive eating). These two illnesses can alternate or follow one another. They are often accompanied by purges or compensatory behavior intended to limit weight gain (making yourself sick, use of laxatives, fasting and physical hyperactivity). In its most severe form, anorexia nervosa leads to a BMI of less than 17.5 and hormonal disruption. It affects between 0.9% and 1.5% of women and 0.2 to 0.3% of men.

Professor Pierre Colon, a dental surgeon teaching restorative dentistry and endodontics, describes the havoc eating disorders wreak in your mouth: “In the first few years of the illness, teeth will become worn and cracked. Most of this damage is due to vomiting, and anorexia, where food is restricted, can also have harmful effects on the teeth. The lifestyle habits peculiar to these patients are always taken into account.”

Dental damage characteristic of eating disorders

Damage to the teeth associated with eating disorders are usually signs of both mechanical and chemical wear. As Professor Colon explains: “The enamel is weakened (eroded) by an excess of acid from diverse origins in the body, and gets thinner until it almost disappears, exposing the dentine which is sensitive. At the same time, this phenomenon is exacerbated by the action of the teeth against each other (attrition) or by inappropriate brushing and even by certain foods (abrasion). The area where the damage is worst indicates the cause.”

Logically, the damage caused by vomiting will be where the stomach acid has come into contact with teeth, mostly affecting the backs of the teeth, facing the palate and at the gum line around the incisors. Over time, the enamel will disappear totally on the insides of the teeth. Teeth wear down into a point and lose their height.

Bulimic episodes and also certain types of food can also mean those suffering from eating disorders may be exposing their teeth to gastroesophageal reflux, often during the night, which means acid erosion can take place without the sufferer even being aware of it. “The damage caused by acid reflux is usually around one side of your jaw according to your sleeping position”, Professor Colon comments.

However, damage can also be caused to the front of the teeth, through drinking a lot of acidic drinks. Professor Colon explains this further: “To fill up an empty stomach or help provoke vomiting, certain patients swallow almost six liters of soda a day. It is actually a well-known fact that these drinks are one of the key causes of acid erosion. You also have to be careful of salad dressings, often acidic like, vinaigrettes with contain lemon juice and mustard…”

The chewing surface of the molars does not escape damage either. There is often not enough saliva present in the mouth, and it is often in bad shape due to malnourishment, so your spit cannot neutralize the acidity in your mouth. The damage to the edges of your teeth which jut out will be worn down into wells which spread and grow. Your molars will end up losing their shape and height.

Finally, in extreme cases of anorexia, the gums can recede so far that they expose the roots of your teeth to acid and to the damaging brushing action of your toothbrush. With the idea of cleansing the body, or to get rid of the taste of vomit, some patients brush their teeth ten or fifteen times a day, sometimes for twenty minutes!

Different types of decay and dental pain

Teeth are weakened by acid erosion, they are not protected properly by saliva and the body’s immune defenses are down, but on top of all this, people who suffer from eating disorders consume more sugary foods, as well, during an attack of compulsive eating. They also drink more fizzy drinks and sugary things in order to make themselves vomit. Tooth decay is therefore rapidly increased.

Due to enamel loss, teeth become more painful and sensitive to the cold, acid, sugar and even brushing. The dentine, naturally more yellow than enamel, stains easily on contact with food and will affect your smile.

After ten years, often at around 28 or 32 years old, the wearing down of your teeth becomes visible, ruining your appearance and affecting your ability to eat, so much so, teeth will even start to crack. “In some patients, the incisors will only be a few millimeters tall, and the molars will barely clear the edge of the gums with gaping holes in the dental arches”, explains Professor Colon. This loss of surface can lead to pain when articulating your jaw, and even trigeminal neuralgia which is an extremely painful condition.”

Stopping the damage to your appearance and dental function

When patients are still battling these disorders, Professor Colon recommends rinsing the mouth after vomiting with tap water, and waiting at least twenty minutes before brushing your teeth. This advice is also applicable after eating acidic food or having fizzy drinks.

Teeth should be brushed vertically, from the gum line towards the ends, and using a technique which allows the bristles of the toothbrush to reach in between the teeth. Use a flexible toothbrush and a non-abrasive toothpaste, ideally formulated for protecting the enamel. “Electric toothbrushes can be useful as certain models cut out when the pressure on the teeth is too strong”, Professor Colon points out. There are also dental treatments available which specifically target erosion.

Often, people who are affected by eating disorders are also smokers, drinkers and often take different drugs which also have an effect on teeth (staining, acid erosion, reduced saliva production and general poor health). On the other hand, chewing sugar-free gum from time to time will stimulate the production of saliva and limit acid reflux.

“The feelings of guilt and shame mean many sufferers do not go to the dentist”, Professor Colon says regretfully, but consulting a dentist means the damage can be limited. When the illness is not being fought off, a dentist might suggest a local administration of fluoride and replacement of lost enamel and dentine with resin which will build the teeth back up, preserving the natural shape and colour of your teeth. “Restorative materials have the advantage of preserving the healthy part of the tooth” Professor Colon points out. Once patients begin treatment, it is possible to achieve perfect results with restorative dental work.”

Sources:

• This figure, provided by Dr. Nathalie Godard (at the Institut Mutualiste Montsouris) comes from a literature review dated June 2008, and concerns all eating disorders. Anorexia and Bulimia represent 5% of cases.
• These diagnostic criteria are taken from the International Statistical Classification of Illnesses and Related Health problems (ICD-10 code by the World Health Organization) and the Handbook of Diagnosis and Treatment of DSM-IV Personality Disorders. Refer to Anorexia Nervosa: Treatment, Official definition by the French National Authority for Health, June 2012, p. 13-14.

*Pierre Colon is a professor at the Paris Diderot University, and a clinical practitioner in restorative dentistry and endodontics for the Garancière dental practice at the Rothschild Hospital (AP-HP, Paris). He is researching the chemistry of materials as part of the Biomaterials and Biological Interfaces team at the Multimaterials and Interfaces Laboratory UMR CNRS 5615 at Lyon 1 University.

Milestones, in association with The Beacon Program, hosts a support group for anyone interested in furthering their recovery with [or seeking help for] an eating disorder. The groups are free and are open to those wishing to learn more about recovering from an eating disorder or to provide ongoing support to those having completed or who are currently receiving treatment. Participation is open to both Milestones alumni and non-alumni alike.

The meetings are scheduled almost every quarter on Sunday afternoon (excluding holidays) from 12:00 pm until 2:00 pm. Groups are facilitated by Marty Lerner, Ph.D., Molly Carmel or rotating members of Milestones and/or Beacon ‘s clinical staff and will also feature guest facilitators during the upcoming months. Topics include a discussion of current research in the field of eating disorders, as well as, a variety of topics relevant to recovery. Emphasis will be placed on the addictive nature, of eating disorders and the role related support groups and professional resources in the area.

The schedule of meetings will be announced via the Milestones website under EVENTS and Beacon websites, as well as, posted on the Milestones FB page and Yahoo Group message board for Milestones.

The Beacon is located at 12 East 44th Street between Madison and 5th Avenues on the 4th Floor For details and a schedule call Milestones 800-347-2364 or The Beacon – 646-559-9019

Our South Florida Eating Disorder Support Group is now held quarterly. We meet at 6:00PM until 7:00PM.

Milestones’ clinical staff rotate facilitating the group along with our nutritionist, which is open to both Milestones alumni and non-alumni alike. The group is free and you may contact our offices at (954) 272-0806 for more information.

For dates and up-to-date information, look under EVENTS on the navigation bar.

To attend in person: (Once restrictions on gatherings are lifted)

Milestones Cooper City Campus is located at 2525 Embassy Lakes Drive, Suite 10, Cooper City, Florida, 33026.

To join us virtually via ZOOM:

Join on your computer: https://zoom.us/j/6013024979

Join on your phone with audio only: Call 1.415.762.9988 Meeting ID: 6013024979

Please call in a few minutes before the scheduled meeting time.

Pennsylvania Eating Disorder Support Group

Milestones in association with the Renaissance Nutrition Center, located at 2500 DeKalb Pike, Norristown, PA 19401, hosts a monthly “Alumni and Friends” open eating disorder support group. A $20 donation is suggested to help cover expenses.

The group has been meeting for nearly 15 years now and meets the 3rd Saturday of every month from 11:30AM until 2:00PM. For details and directions, please call 610-275-3699.

The group is facilitated by various professionals in the community as well as staff members from Milestones.

The group also hosts a yearly weekend retreat at various hotels and resorts in the NJ/NY/PA area.