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Eating disorders are in the news:
-The percentage of women in their 40s suffering from anorexia doubled in the 1990s.
-Therapists say they're seeing more males with the problem.
-Researchers believe genes may explain a person's predisposition to anorexia or bulimia nervosa, the two major eating disorders.
Advocates welcome the increased awareness.
"These are serious illnesses that deserve and require a lot more attention," said Doug Bunnell, president of the National Eating Disorders Association.
"We continue to battle the impression that eating disorders are relatively benign and somehow limited to young adolescent females who are really vain."
While media images glamorize excessive thinness, the mortality rate among people with anorexia has been estimated at 0.56 percent per year, or 5.6 percent per decade. That is the highest mortality rate of any psychiatric illness, Bunnell said.
Because eating disorders are complex, involving both mind and body, they are often misunderstood. Food is only part of the problem.
Eating disorder behaviors, whether starving or bingeing and purging, help victims "not to think about the things that seem as if they're unresolvable," said Vivian Hanson Meehan, founder of the National Association of Anorexia Nervosa and Associated Disorders.
"Most people with an eating disorder tend to be perfectionistic. Not wanting to displease anyone. And feeling that one needs to have control over every part of one's life," Meehan said. "What the eating disorder does is give you a feeling of control."
Anorexia nervosa was first described about 100 years ago in England and France. But the general public knew little about it until the 1970s. In 1983, the death of singer Karen Carpenter, from complications of anorexia, brought greater attention. Research shows that between 0.5 percent and 1 percent of all people will develop anorexia. Bulimia, which involves bingeing and purging, affects about 3 percent.
Researchers say eating disorders affect females and males from all socioeconomic and ethnic backgrounds. About 1 in 10 diagnosed patients are males.
Cynthia Bulik, president of the Academy for Eating Disorders and director of the University of North Carolina Eating Disorders Program in Chapel Hill, N.C., is among those who believe genetics plays a role.
Someone with a genetic predisposition for an eating disorder may get "hit by some lightning bolt in the environment," such as sexual abuse, that leads to the use of an eating disorder as a coping skill, Bulik said. On the other hand, someone with the predisposition may be protected by certain factors, such as having parents who are good at bolstering self-esteem.
People who have been abused physically or sexually are at higher risk for eating disorders. They are also associated with obsessive-compulsive disorder, depression and anxiety disorders.
People who develop eating disorders often do so, at first, in response to cultural pressures to be dissatisfied with their bodies.
Losing weight gets them attention. Then, they realize that "they can starve better than anyone or they discover that they can binge, purge, and still eat whatever they please," Meehan said.
Parents, especially mothers, have been thought to contribute to the problem, but many therapists now believe treatment should include the family.
"We've come to realize that the family's essential," said Nancy Zucker, director of the Duke Eating Disorders Program at Duke University in Durham, N.C.
"My experience has been these are very loving families, but we could all use some skill-building, to make them a stronger family," Zucker said.
Families must realize that "an eating disorder is a coping strategy," she said. "Treatment has to help the individual learn an alternative coping strategy."
Treatment for anorexia nervosa must begin with gaining weight. "These women and girls actually can't think well enough when they're very underweight to engage in psychotherapy," Bulik said. "Their brains just aren't working."
Research shows that cognitive behavioral therapy - learning to recognize unhealthy thoughts that maintain unhealthy behavior and replace them with healthier alternatives - is particularly effective for bulimia, but is also used for anorexia.
The anti-depressant Prozac appears to help ease the anxiety of patients with bulimia, but "we don't have a pill for anorexia nervosa," Bulik said.
Therapists agree that people with eating disorders can get well, but it takes time and money. Health insurance often doesn't cover the treatment, and for that reason, many programs have closed their doors. The Chapel Hill program opened in August is the only inpatient program between Maryland and Florida.
"Most people don't have access to enough care and probably not good enough care," Bunnell said. " It's often a lengthy process with lots of ups and downs."
About Eating Disorders
-Anorexia nervosa: Characterized by aversion to food and obsession with weight loss.
-Bulimia nervosa: Characterized by recurrent cycle binge eating followed by purging, either with laxatives, diuretics, self-induced vomiting or excessive exercise.
-Binge-eating disorder: Characterized by obsession with high-calorie and high-fat foods. Eating is emotionally based and often done in secret.
-Females are more likely than males to develop an eating disorder. About 7 million U.S. girls and women have diagnosed eating disorders, compared to 1 million boys and men. One study showed that 86 percent of victims reported the age of onset of the illness by age 20; 77 percent reported the duration of illness from one to 15 years; only 50 percent reported being cured.
-Treatment often requires psychological counseling and extensive medical monitoring over many years. Inpatient treatment can be $30,000 or more per month. Many patients need repeated hospitalizations.
-Health insurance often will not reimburse for treatment.
Source: National Institute of Mental Health, National Association of Anorexia Nervosa and Associated Disorders, therapist Ann Kreindler-Siegel.
(c) 2003, The Charlotte Observer (Charlotte, N.C.). Distributed by Knight Ridder/Tribune News Service.