Eating disorder

The common denominator for eating disorders is a disillusioned picture of the body, with a subjective experience of fatness and a strong will to loose weight. Eating disorder can more or less be a conscious way of controlling or suppressing feelings, or an attempt to increase self-assertion or mastering in a difficult situation in life.

A few years ago the only diagnosis for eating disorders was anorexia nervosa (refusal to eat mentally conditioned). Today we also talk about bulimia nervosa, which involves eating without control for a limited period of time, and then throwing up or dispose of the food another way. Many who suffer from an eating disorder first have anorexia then bulimia.

Weight loss is the clearest sign of anorexia nervosa. It is usually 15% lower that expected weight, or with a body-mass index (kg/height² with height in meter) below 17.5. the weight loss is self-induced as a result of avoiding "fat food". Many try to loos the food by vomiting or extreme physical activity. Others use medications such as laxatives, diuretics or ecstasy to diminish their appetite. Using these medications is injurious. In many case the use of medications combined with vomiting produces hormonal changes.

Bulimia nervosa does not cause a great weight loss, however it is characterized by a continuous interest for eating and an irresistible urge for food. Episodes of overeating occur, where large amounts are devoured in very short time. These episodes are usually an attempt to be relieved of psychological problems or stress, at the same time as they cause shame and guilt. A person who suffers from bulimia nervosa tries like the anorectic to dispose of food by vomiting, abusing medications like laxatives, appetite reduction pills or diuretics, or they have periods of starvation. As the anorectic a bulimic also fears overweight and have unrealistic weight limits.

Symptoms of eating disorder simultaneously become symbols of a concrete way of expressing and mastering psychological problems. The person with the eating disorder perceive this first and foremost as a solution, and a way of handling a problem, while his surroundings see this as a problem. Over a longer period of time this type of solution or mastering create a new problem, because the symptoms and complications can sometimes become fatal.

Just above 22.000 women in Norway suffer from serious anorexia nervosa or bulimia nervosa. If we include those with other forms of eating disorder and mild anorexia and bulimia, but still need treatment, the number is 50.000. the incidence is lower amongst boys/men than women, but no available data can suggest a number.

Risk of developing eating disorders

No one can point to a particular reason why some children and youth develop serious eating disorders and other do not, while they are all exposed to the same weight oriented culture. Role models are very central in this context. The "thinness culture" becomes a reality when people with a normal weight normalise dieting and render it harmless for children and youth. Idols and models are important role model in our culture, however, the danger first occurs when a role model is a person whom you not only look up to, but whom you also know and can easily identify with.

The risk of anorexia is closely related to exaggerated perfectionism, where nothing is ever good enough and there a few close friends and a limited social network. Low self-esteem and negative self-evaluation enhances the risks of all serious eating disorders.

The risk factors are universal and cannot be transferred to the individual. There are many ways in to a serious eating disorder. However, youth moving away from home to start studying seem to be in the danger zone. If you perhaps struggle with impulse control, it might be difficult to control meals and other things, especially without the set meals from home, and your parents watching. This might also be the case for the perfectionists, who are used to being first and best, and who meet many of the same kind at the university. The demands of being best and establishing a network at the same time, are hard, and isolation might seem like a good solution. Many students fall in to a bad circle where weight loss and low weight are ways of feeling successful.

The psychology in relation to eating disorders is focused on suppression of own needs and feelings, especially for anorectics. This is expressed by refusing food. The weight loss also diminishes other needs.

Eating disorder can also be related to want of closeness, a closeness that they also fear. Many choose to suppress all feelings including want, and refuse themselves everything, including food. Others assuage the feeling by over eating, and are seen by themselves and others as greedy.

Eating disorders are also connected to shame and guilt in relation to looks, body, own needs or over eating and vomiting.

Anger is also a central characteristic of eating disorders. There is no room for aggression at home or outside. It is better to punish one self: keep the aggression and the powerlessness down by being empty or diminish the feeling by eating and then throwing up both food and feelings.

Eating disorders are also connected to loneliness. In the "full-time project" called the body, there is not much room for anyone else. The individual suffering from an eating disorder does not dare, or is not able to share a tired body and a chaotic or empty life with anyone else.

Last but not least, eating disorder is closely connected to anxiety. Anxiety for not suffice. Anxiety for life and death. Anxiety for starting to eat. Anxiety for not being able to stop eating. Anxiety of loosing control. Anxiety for gaining weight. Anxiety for being different and for not being seen. Anxiety is a recurring theme for most people suffering from an eating disorder, and it has great impact on their daily lives.

Physical complications

Too little of everything is the result of reducing your meals and weight loss. The weight loss makes the body defend itself by starting on it's back burner. Eating disorder involves too little supply of energy, vitamins, minerals, tracer metal, proteins, essential fatty acids and fibre that can cause deficiency disease and reduction of muscle mass (including the heart muscle) and osseous tissue. It also includes reduced height, heat production, the number of red and white blood corpuscles and platelets. Weight loss also produces food fantasies and a number of mental symptoms such as mood swings. Many can first experience a feeling of excitement and joy due to the body"s own morphine, but later they experience depression and social withdrawal.

Professional help - Examples of so-called "low threshold services"

Both public and private institutes have so-called "low threshold services". The public offers are for examples this web site, and the Student Counselling Service. You need no formal reference and the person you talk to has patient confidentiality. Here, you are entitled to a mapping that can determine whether or not you need more specialised help. The mapping should include self-esteem, how you experience your body, problems concentrating, tiredness, your relationship to food, changes of your weight including use of damaging techniques of regulating weight such as vomiting, laxatives or diuretics. Those who suffer from a serious eating disorder usually hesitate to use these offers. Many are ashamed and find it very difficult to talk about dieting, weight, over eating, vomiting and how you hide your problems. Others are not motivated at all because they do not acknowledge that they have a problem.

Rådgivning for spiseforstyrrelse (ROS) (Counselling service for eating disorders) is a nationwide organization for all those affected by eating disorder, focusing on the family and friends of the sick person. The organization has several local offices and is a member of the Funksjonshemmedes Fellesorganisasjon (FFO) (the national organization for disables). For more information see Nettros. Another organization is the Interest group for women with eating disorders (IKS). IKS also has local offices and a very good and useful web site IKS with information and link.

Public treatment of eating disorders

A reference from your doctor will open doors to the public health service. Unfortunately, many students do not have these offers because they move away from home and forget to choose a new doctor where they are studying.

Treatment is first and foremost therapy in forms of conversation. In some cases your doctor can offer sufficient help, however most times you need reference to a psychiatric polyclinic, a private psychologist or psychiatrist or to a medical or psychiatric hospital.

Literature for more information