When an eating disorder exists, it is recognized by certain behaviors, the most noticeable being an obsession with food and weight. This obsession can take the form of binge eating, starving, vomiting, compulsive exercising or other behaviors focused on eating, getting rid of, or avoiding food. Eating disorders, however, are not merely problems with food. They are severe psychological disorders, many aspects of which are not apparent to an outside observer. It is often not easy to tell who is and who is not suffering from an eating disorder since so many of the behaviors remain hidden. Also, dieting, exercising, fasting and a preoccupation with food and weight are so much a part of our culture, we tend to think the early signs of eating disorders are just typical attempts to look ones best in a society based on appearances.

ANOREXIA
Anorexia is characterized by a significant weight loss due to a purposeful attempt to stop eating. The Anorexic, intensely fearful of becoming obese, considers herself to be fat--no matter what her actual weight. Anorexics close to death at 65 pounds will show you where on their bodies they feel they need to lose weight. In an attempt to be even skinnier, the anorexic avoids taking in calories at all costs--even if the cost is her life. The attempt to lose weight usually occurs through induced starvation, but anorexics can accelerate weight loss or undo the damage of occasional binges by vomiting, taking laxatives, using diuretics, or exercising rigorously. No one starts a diet with the intention of becoming anorexic. However, for the person who is to become anorexic, the dieting and weight loss quickly take on a function that is unanticipated and unplanned. As the person begins to lose weight, she feels a newfound control where she previously did not feel effective or strong. The overwhelming majority--95 percent--of anorexics are women. The age of onset is usually between 12 to 18 years, occurring in those who have not developed sufficient means of feeling competent, worthy and effective. The pre-anorectic is often the model child, rarely complaining, usually very helpful, compliant and eager to please. The anorexic strives to be perfect and her emphasis on perfection, in combination with the impossibility of achieving it, leads her to strenuous and relentless attempts to do better.

BULIMIA
Bulimia is usually characterized by bingeing that is eating large amounts of food in a short time. The binge is followed by an attempt to get rid of the food and consequent calories, in what is called the "purge. You cannot tell that someone is bulimic by her weight. Bulimics may be slightly underweight or overweight, but are usually within a normal range. Some bulimics go to restaurants, order a full-course meal, throw up, then go to another restaurant and binge again. Some women have such an extreme addiction to food that the binges cost them upward of $60 to $70 a day. Bingeing usually occurs in secret and leaves the bulimic shamefully despising herself and wanting to undo the damage of the binge. Purging most often involves vomiting or laxative abuse. Other forms include the use of diuretics, enemas and/or amphetamine/cocaine abuse. Bulimia usually starts in adolescence or young adulthood, often beginning at transition points of independence (such as leaving for college, getting married). Bulimics tend to be people who do not feel secure about their own self-worth. They feel dependent on others for approval and appreciation and rely on others' judgments to determine their worthiness.

Treatment
Eating disorders represent serious psychological problems that can actually cause serious medical complications and even death. Treatment for eating disorders needs to be specialized to the underlying issues involved and the particularly difficult problems associated with recovery from them. The ASAP Treatment Programs at Anacapa Hospital have therapists specializing in eating disorder problems to provide the emotional and physical treatment necessary for the person suffering from anorexia, bulimia and related eating disorders.