WEIGHT CONTROL: THE SPECTRUM OF EATING DISORDERS
Most of us know people who exhibit what seem to be peculiar eating patterns, from self-professed “chocoholics” to the college student on a macrobiotic diet. Yet these unusual habits seldom represent a true eating disorder. Understanding just what qualifies as an eating disorder begins with basic definitions of the terms.
Anorexia-self-starvation-was first described as a clinical syndrome three hundred years ago. Yet only within the past few decades have eating disorders been widely recognized, not just by the public but by physicians themselves. Even as I write, controversy rages, here and abroad, over the exact nature of these disorders. This debate is more than mere medical hairsplitting; a precise understanding is crucial so that therapy can be developed and applied.
Anorexia and bulimia may appear to be different illnesses with different symptoms. Anorexia is characterized by starvation; bulimia is notorious for its cycle of bingeing and purging. While there are distinctions between the two conditions, it is also true that they have certain features in common.
Both anorexics and bulimics overvalue bodily thinness. The flip side of this attitude, and of equal importance, is an exaggerated fear of fatness. These highly prized but basically unhealthy concepts are constantly reinforced by social pressures and cultural signals.
Both disorders also involve an obsession with food. As the disease progresses, patients get caught up in the rituals of acquiring, preparing, and consuming meals. In time, thoughts of food come to dominate every aspect of their lives, at the expense of family, friends, careers, and, of course, health.
Eating disorders are “spectrum” disorders. Like the spectrum of light in a rainbow, anorexia and bulimia appear in a range of intensities. Think of anorexics as occupying the red end of the spectrum, with bulimics at the violet end. Both “colors” are highly intense but are of different hues. In between are many variations of the illness, each with a distinctive “color,” or pattern of symptoms. There are several types of patients with eating disorders, especially among those with bulimia. The main difference between them may be simply the severity of their symptoms.
Looking at a rainbow, it is difficult to tell exactly where one color ends and another one begins. The colors seem to slide into each other, overlapping at certain critical points.
The same can be said of eating disorders. Women who start off with anorexia find it difficult to maintain constant starvation. So they eat. They then often adopt such measures as self-induced vomiting in order to keep their weight down. Conversely, patients who begin by bingeing and purging may eventually try starvation as their only means of restricting food intake. This passage from one kind of eating strategy to another affects the treatment they require. Anorexic patients, for example, fear that learning how to eat normally may result in urges to binge.
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