AAMFT Consumer Update
Eating Disorders

Eating disorders are extreme disturbances in an individual’s behavior and feelings related to food, weight, and body image. They are most likely to develop in young women, during adolescence and young adulthood. But children, preteens, adult women, and men also may develop these problems. They are serious problems with life-threatening consequences.

Anorexia Nervosa is characterized by excessive weight loss through self-starvation and sometimes through purging. Purging includes vomiting, using laxatives, and exercising excessively. Symptoms include:

• Refusal to maintain a normal weight
• Intense fear of weight gain
• Obsessive preoccupation with weight and shape
• Loss of menstrual periods
• Distorted body image

Bulimia Nervosa is characterized by cycles of binge eating followed by purging, usually done in secret. The individual’s weight may range from below to above average, so it may be harder to detect. Symptoms include:

• Repetitive cycles of bingeing and purging
• Feeling out of control of food intake
• Purging after bingeing via self-induced vomiting, laxatives, diet pills, diuretics, excessive exercise, or starvation
• Obsessive preoccupation with weight and shape

In addition, some people may have a mixture of anorexia and bulimic symptoms without qualifying for either diagnosis. They may engage in compulsive overeating or bingeing without purging. Preoccupied and significantly distressed about their eating habits, they may gradually gain weight to the point of obesity. Many people have both symptoms of anorexia and bulimia. Men are most likely to lose weight or to purge by excessively exercising.

Eating Disorders "Eat Up" Relationships

Eating disorders are consuming. They consume the individual in obsessive, negative thinking and behaviors, and they consume the individual’s relationships with family members, loved ones, and life. This is partially due to the effects of starvation. When people are not adequately nourished, they think about food constantly, sometimes even dreaming about it. They also become depressed, isolated, and tired. They avoid relationships because they often feel others pressure them to eat. They are physically depleted, and feel compelled to engage in eating disordered behaviors.

Loved ones find eating disorders extremely difficult to understand and accept. Seeing someone you love starve or damage her or his body is stressful. Often, parents, spouses, and others begin to become intrusive in their efforts to get the person to eat or to stop purging. Soon, the individual may see these loved ones as enemies trying to control her or him rather than help.

Eating disorders may develop if a person has no other way to speak or represent feelings. Frequently family dynamics, problematic communication patterns, losses, or stresses like abuse have contributed to negative feelings the person could not deal with directly. It is never a simple matter that can be solved by just telling the person to eat. The symptoms have become the individual’s way to avoid facing problems more directly or are an attempt to feel in control when the rest of life feels out of control.

Feed Your Relationship by Getting Help

Although eating disorders vary in severity from mild to life-threatening, they usually don’t go away by themselves. People with eating disorders often fear getting help because it could be seen as a sign of weakness. Loved ones can help break through that by being open to getting help themselves and by examining how they or other family relationships or issues may have contributed. In a family, both fathers and mothers need to be involved in treatment. This challenge needs to be shared.

Serious Distress Signals

When someone:

• Fasts or severely restricts food intake
• Hides or sneaks food
• Spends excessive time in the bathroom after meals
• Vomits, takes laxatives, diet pills or other medications to lose weight
• Has lost a significant amount of weight
• Is tired and depressed
• Can’t concentrate
• Has irregular periods, swollen glands or joints, broken blood vessels or bloodshot eyes.
• Wears layers of clothes even in warm weather
• Faints or passes out

When these or other signs are present, professional help is urgently needed. Make an appointment with a physician and with an expert in eating disorders to find out how serious this is and to design a treatment plan that will help you cope.

What Helps?

Usually people with eating disorders need an interdisciplinary approach, including individual and family or couples therapy, nutritional counseling, medical monitoring, and sometimes medications or group therapy. Depending on the severity, inpatient, day hospital, residential treatment, or even tube-feeding or intravenous fluids may be necessary.

The sooner someone gets treatment, the more likely it is that person will recover. Get help soon. Treatment is effective. As many as 75 percent of those afflicted by anorexia or bulimia will recover. The remaining 25 percent will be chronically ill and some will die. Family or marital therapy significantly improves the possibility of recovery. Family members and loved ones need to understand that the problem is not a simple one. Advice to "just eat" won’t help. The eating and body image issues cover up much more complicated feelings. The eating disorder is an illogical system of thoughts and behaviors, and is an attempt to solve deep self-esteem and identity problems and gain a sense of control over one’s life. But, remember that there is hope and effective treatment for eating disorders.

References and Resources

Your Dieting Daughter: Is She Dying For Attention? By Carolyn Costin. Brunner/Mazel (1997). A great resource for parents to help them understand the psychological factors prompting a girl to diet, and to distinguish between diets and eating disorders. It includes sound nutritional advice, distinctions between "fit or fanatic" exercise, and a discussion of family issues.

When Girls Feel Fat: Helping Girls Through Adolescence. By Sandra Friedman. Harper Collins Canada (1998). Beautifully explains how girls translate their feelings and disappointments into self-degradation and "the language of fat." A resource for parents, educators, and others guiding girls. Full of practical advice and theory.

Eating Disorders: A Reference Sourcebook. By Raymond Lemberg (Editor). Oryx Press (1999). Short articles by leading experts include discussions of symptoms and causes, physiological and medical issues, sociocultural contributions and risk factors, dieting and obesity, and treatment strategies. It includes a directory of treatment facilities and an extensive resource list, including books, videos, internet sites, and organizations.

Father Hunger: Fathers, Daughters, and Food. By Margo Maine. Gürze Books (1991). The only book to explore how fathers contribute to their daughter’s body image, weight preoccupation, self-esteem, and eating disorders. Includes practical solutions for fathers, mothers, and daughters on how to improve family relationships and reconnect.

Surviving an Eating Disorder: New Perspectives and Strategies for Family and Friends. By Michele Siegel, Judith Brisman, and Margot Weinshel. HarperPerennial (1997). Practical help for families trying to understand and live with an eating disorder. Gives both a dynamic understanding of the family context and advice regarding day-to-day issues such as anger, denial, secrets, and meals.

National Eating Disorders Association
603 Stewart Street, Suite 803
Seattle, WA 98101
A nonprofit organization dedicated to increasing the awareness and prevention of eating disorders through education and community activism. Call (800) 931-2237 or (206) 382-3587 for information.

The text for this brochure was written by Margo Maine, PhD.

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Keywords: anorexia, bulimia, underweight, binging, purging.

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The American Association for Marriage and Family Therapy (AAMFT), the professional organization representing marriage and family therapists, believes that therapists with specific and rigorous training in marriage and family therapy provide the most effective mental health care to individuals, couples, and families. This brochure is courtesy of:
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