Dying To Be Thin

Feb. 17, 2009
Anorexia nervosa is a type eating of disorder; it is related to an individual's intense fear of gaining weight. It is estimated that 1 in 5 anorectics will die. The disorder usually begins in the teen years, most commonly between the ages 13 and16.

Anorexia nervosa is a type eating of disorder; it is related to an individual's intense fear of gaining weight. Sufferers severely limit the amount of food they eat until they become life threatening malnourished. While only one percent of the population has the disorder, it is the most deadly mental illness there is. Up to 20% of individuals with anorexia nervosa will die from the disease. Ninety percent of the victims of anorexia are female; the disorder kills 5,000 American women a year. However, very little is truly understood about this disease. Celebrities who have suffered with anorexia nervosa include Mary Kate Olsen, Tracey Gold, Jane Fonda, Jamie-Lynn Sigler, Sally Field, Paula Abdul, Victoria Beckham, Justine Bateman, Joan Rivers, Whitney Houston, and Carrie Otis.

Anorexia usually begins in the teen years, most commonly between the ages of 13 and16. Those at highest risk for the disorder are individuals who are in a job or do a sport that stresses body size such as modeling, dancing, or gymnastics. Anorexia usually begins benignly, starting with a diet, which is often encouraged. However, this diet and a distorted body image continues to progress to an obsession in an anorectic. This obsession takes control over all other aspects in an anorectic's life; the diet becomes stricter, purging behaviors may co-occur. Eventually the body, mind and spirit are affected, and sometimes it is simply too late.

Typical Profile of an Anorexic

Allison was 19 years old when she died from a heart attack caused by severe malnutrition while attending a college in the Midwest. Her eating disorder began six years earlier. Allison was a bright child, but was prone to anxiety. She demonstrated obsessive compulsive behaviors such as lining items up, then relining them. Even as a child she was a perfectionist. She was shy and awkward in social situations. Although Allison was an honor student throughout junior and senior high school, as well as being on the gymnastics team and a gifted pianist, she never felt good about herself or her achievements. Her self esteem was chronically in the pits, constantly felt inadequate, and sometimes she believed she was defective.

When she was thirteen her gymnastics coach teased her about a slight roll in her middle. Allison took this very seriously. She began studying her body in the mirror. She also began to take notice of the rail thin models and actresses on television, in movies, and in advertisements. Once again, she felt inadequate. She began a calorie restricting diet; she knew how to do this because her mother was constantly dieting. She trimmed down which her coach, parents and peers noticed. However, that wasn't enough. If thin was good, thinner was better, and thinnest was best. Allison became dreadfully afraid of gaining an ounce of weight. She studied the calories of all foods, as well as recipes. She began behaving oddly when eating, cutting food into tiny pieces, spreading the food around her plate and chewing each morsel 27 times. Her weight continued to drop, but every time she looked in the mirror she could only see fat. She began to realize that if a restrictive diet, in and of itself, couldn't make her the thinnest she could add extensive exercise, or purge by vomiting or abusing laxatives and/or diuretics. Her parents worried as she began to appear emaciated. She denied she had any problem, insisting she needed to keep her weight down to make the next gymnastics level. She became increasingly secretive about her food intake and would make up excuses for not eating with the family, or frankly lie about her food consumption. She started wearing baggy clothes in attempt to keep people from confronting her. Her life slowly but completely became a relentless pursuit to be thin.

Allison began experiencing physical symptoms and complications of starvation. She had her first menstrual period when she was 16; she only had one other period, 2 years later. She would complain about feeling cold, weak, faint and fatigued frequently. Her hands and feet would swell. She developed a layer of baby-fine hair all over her body called lanugo, and her arms and legs had a purplish color to them due to poor circulation. Her blood pressure fell and her resting pulse was 45 beats per minute as her body tried desperately to conserve energy. She cannot sit for longer than five minutes because she has no fat pads on her buttocks. The more concerned her parents became, the more withdrawn from them she became. This ultimately led to her decision to live on a college campus several hundred miles from her parents' home. Additionally, this move allowed Allison to be in control of everything; her life, schedule, friends, food, and especially her own body.

Unfortunately, the new stresses of being a coed intensified many of her negative feelings. She became increasingly anxious and depressed. She considered suicide. She always fought these feelings and thoughts off with her only coping mechanisms: diet, exercise, and purging. By her sophomore year of college Allison, who was 5'6", weighed only 86 pounds. Her body mass index (BMI) was 13.88; the World Health Organization considers a BMI of around 16 to be starvation. Her diet consisted solely of 6 lettuce leaves, 6 cherry tomatoes, and 3 Diet Cokes a day.

Allison’s parents received news that she had collapsed on her way to class. She had been taken to the hospital by paramedics but died in route. An autopsy later revealed that she had died from a heart attack after her heart had become smaller and weaker. Her brain had also shrunk significantly. Allison also had signs of kidney failure, due to malnutrition, dehydration, vitamin deficiencies and electrolyte imbalances. Additionally, at the age of nineteen she had developed severe osteoporosis as her bones had also thinned.

Diagnosis of Anorexia Nervosa

Anorexia is diagnosed based on the following criteria:

  • Refusal to maintain body weight at or above a minimally normal weight for age and height (body weight less than 85% of that expected)
  • Intense fear of gaining weight or becoming fat, even though underweight.
  • Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
  • In females, the absence of at least three consecutive menstrual cycles or failure to reach puberty.

The disorder is further broken down to two distinct types. In the restrictive type the individual simply follows a very restrictive diet. The binge eating/purge type relates to the individual also engaging in self induced vomiting, or misuse of laxatives/diuretics/enemas.

Treatment

The goal of treatment is to support any medical or nutritional needs, promote a healthier relationship with food, and to teach more constructive ways to cope with stressors. Depending on the severity of the disorder and other psychosocial symptoms or factors, there are many treatment options for anorexia nervosa. In some cases hospitalization (especially if the victim is medically compromised) or residential treatment may be required. However, many anorectics can be successfully treated in outpatient settings. It is important that a patient gets a multi-disciplinary approach; which should include a medical physician, nutritionist, psychiatrist, therapist, and peer support. Family therapy is also highly recommended. Research is still being done to see which psychiatric medications are helpful in the treatment of anorexia. An antipsychotic, Zyprexa, has been shown to help anorectics start eating and gain weight.

It is reported that approximately 1/3rd of anorexics fully recover, another 1/3rd may relapse and continue to struggle with the disorder, and the final 1/3rd remain chronic cases. Unfortunately, treatment for anorexia can come with a hefty price tag. Inpatient treatment can cost about $30,000 a month. Outpatient treatment can cost over $100,000.

Law Enforcement Calls for Service

A dispatch call for service related to anorexia is usually from a desperate family member who can no long watch a loved one, especially a son or a daughter, physically waste away before their eyes. Their pleading for the loved one to eat adequately has been to no avail. Vague ultimatums have failed. So who do you call when you have no other options? 911.

The call will probably come out as a check the welfare, suicidal threats, or grossly mentally disorganized. The family's hope is that you, Mr. Officer, will be able to persuade the loved one that they must eat, or you will convince them to go with you voluntarily into treatment, or that you will be able to take them away and force them into hospitalization.

Jurisdictions vary greatly on whether an eating disorder qualifies for a sustained commitment to a psychiatric hospital. These differences are generally based on false assumptions and mistruths about the nature of the disorder. Nonetheless, as noted previously anorexia nervosa has the highest mortality rate of any psychiatric illness. When an individual is in an acute life-threatening phase of the disorder, they are clearly an imminent danger to themselves. The condition, at this point, meets legal criteria for involuntary admission to a hospital for life-saving treatment. This is especially evident when the anorectic does not have the mental capacity to realize or accept that they are putting their life in severe jeopardy; which would give grounds for an involuntary admission as a gravely disabled minor or adult.

Below are some quotes to include in the body of an officer's petition for a 72 hour involuntary application to a psychiatric hospital. Remember to always write a hold with "probable cause" in mind.

  • Refusal to consume adequate nutrition so as to maintain their health
  • Endangers health by gross negligence in needed diet and nutrition
  • Unable or unwilling to follow medical instructions regarding treatment and self-care essential to health or life
  • Loss of weight (or other evidence of malnutrition) due to not eating or lack of proper food
  • Is in danger of physical harm arising from complete neglect of the basic need for food which could render serious illness, or death if care by another is not taken
  • Will continue to suffer severe mental, emotional, and physical distress if untreated which will have significant impairment on his/her health, judgment, and behavior.

If you are a school resource officer, you will likely encounter an adolescent with an eating disorder. Learning to recognize the symptoms of anorexia and having useful resources to provide the teen or his/her parents can help stop a disorder from progressing.

Referrals

  • The National Association of Anorexia Nervosa and Associated Disorders provide hotline counseling, a national network of free support groups, referrals to health care professionals, and education and prevention programs. www.anad.org / 847-831-3438
  • The National Eating Disorder Association serves as a clearinghouse of educational information and treatment referrals. www.nationaleatingdisorders.org / 206-382-3587
  • The websites www.somethingfishy.org and www.myselfhelp.com have chat rooms for individuals and families

Prevention

If you are a parent you may want to rethink some of the ways that you, culture and the media represent the quest for the perfectly thin body. Provided are some points to ponder:

  1. An adolescent female is 10-20 times more likely to have an eating disorder if a family member also has/had one.
  2. Parents who overvalue physical appearance can unwittingly contribute to an eating disorder.
  3. Model self acceptance of your own weight and body appearance and watch what you say. Making statements like "I can't eat that; it will go straight to my hips," or asking, "Does this dress make me look fat?" can send the message that thinness is the ultimate goal in life.
  4. Odd feeding schedules in infancy can lead to an eating disorder.
  5. Using food for rewards, punishment, comfort or other non-nutritive purposes can also lead to an eating disorder.
  6. Nagging about junk food and limiting a child's access to treats will actually increase his/her desire to eat too many of these foods; even if they are not hungry. This can also lead to an eating disorder.
  7. If your child exhibits anorectic behavior feed him/her. Supervise their eating behavior, jack up the calories (up to 4,000 calories a day to replace lost weight) and limit exercise. Therapy won't be of much help to a person who has no glucose in his/her brain.
  8. Discuss the media's effect on pushing unhealthy dieting and life-threatening thinness with your child. It is estimated that the average American child will watch approximately 21 hours of television each week, and see more than 30,000 commercials a year. Actors and actresses who are the most successful and happy are invariably young, attractive and super thin. According to Health Magazine 1/3rd of female television network characters are underweight; however only 5% of population is underweight. Whereas, only 3% of female television network characters are obese, compared 25% of females with obesity in the real world. The message is loud and clear; try this diet or this product and look acceptable (maybe even as good as the 6 foot, 100 pound, "size zero" model who is smiling at you).

About the Author

Pamela Kulbarsh

Pamela Kulbarsh, RN, BSW has been a psychiatric nurse for over 25 years. She has worked with law enforcement in crisis intervention for the past ten years. She has worked in patrol with officers and deputies as a member of San Diego's Psychiatric Emergency Response Team (PERT) and at the Pima County Detention Center in Tucson. Pam has been a frequent guest speaker related to psychiatric emergencies and has published articles in both law enforcement and nursing magazines.

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