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By Melissa Tennen, HealthAtoZ writer
Anorexia or Bulimia. What comes to mind? A phantom of a 15-year-old girl who eats nothing but lettuce and carrots. And when she looks at a mirror, she sees a gluttonous slob. Or a woman with bulimia who stuffs gallons of ice cream and doughnuts only to rush to the bathroom with fingers down her throat. However, eating disorders are never that cut and dried. At least 10 million females and 1 million males are struggling with eating disorders such as anorexia, bulimia and binge eating disorder. You or someone you know may have an eating disorder. Read what Diane Mickley, M.D., a past co-president of the National Eating Disorders Association and founder of the Wilkens Center in Greenwich, Conn., says.
Don't eating disorders mean you don't eat anything?
Diane Mickley: One of the most common myths that I hear in my office is: "I eat so I couldn't have an eating disorder." These patients think that if they eat some calories that they don't have anorexia. But actually, they are just taking in far fewer calories than they need and that is dangerous.
Isn't eating lots of salad and no fat good for your health?
Mickley: People with anorexia believe they are healthier than the general population because they don't eat a lot of fat and eat lots of salad. But it's like a car. If you have good tires and a good frame but you don't give it enough fuel, then you will run the car down just like your body.
Some fat in your diet is good and necessary. And variety in your daily foods such as getting enough protein from dairy and meat products is also important to build muscle and keep your energy levels up. You also need carbohydrates, particularly if you exercise.
Aren't people with eating disorders bone thin?
Mickley: That's a big misperception. People at normal weight say, "I'm not thin enough. How could I have an eating disorder?" A lot of overweight people and average weight people have eating disorders. You don't have to be skeletal to have an eating disorder. Weight goes up and down, and eating disorders tend to wax and wane in their severity. It's the eating patterns and attitudes themselves that cause the most danger.
If there is such a health risk, why do people continue to do it?
Mickley: They say, "I can't be in any medical danger. I feel fine." Anorexia is an illness that is based on delusions. That means you lose your perception as to how much physical danger you are in and you may not recognize the dangers.
With eating disorders, you are damaging your heart, your bones, your entire body's functioning. You aren't getting the calcium you need or the vitamins and nutrients for proper brain functioning. Your electrolytes may be out of balance. But eating disorders lull people into thinking they are OK.
One of the risks of celebrities with eating disorders is that teens, who lack the maturity to understand the dangers, may think it can't be that bad and even see it as alluring.
Won't supplements protect someone with the disorder from these health affects?
Mickley: No. The deficit in anorexia is in calories and usually protein and fat.
But if eating disorders affect the body so adversely, how can my child be doing so well in school if she has an eating disorder?
Mickley: Parents think that if their child is getting straight A's, then she must be OK. But these children may be very motivated to begin with. They may be overly compensating with their amount of effort to cope with what they are losing in mental functioning.
With starvation, you may not think as well. But if you are smart and motivated, you overcome it.
What about people who may not eat all day but have a large meal in the evening?
Mickley: Eating that way may be considered unhealthy or even a part of disordered eating patterns but it may not be an eating disorder. There are certain mental processes that go along with eating disorders that may not be the same as disordered eating patterns.
Aren't eating disorders only for teenaged girls?
Mickley: Although eating disorders are more prevalent among women, a significant number of boys and men experience eating disorders. And eating disorders can happen at any time in a person's life, although they most commonly begin in the teens and 20s.
Isn't this just a phase? Couldn't the person with the eating disorder just snap out of it?
Mickley: Eating disorders are not normal phases and are not something that should be ignored. Eating disorders are serious mental disorders. An anorexic might say, "I could gain weight if I want to." And a bulimic might say, "I could stop binging and purging if I want to."
People with eating disorders don't have this choice. In many situations if the person doesn't get help, they probably can't stop on their own and may turn a curable disease into a permanent one.
Won't I feel better if I lose the weight? What's wrong with that?
Mickley: "If I lost 10 pounds, then everything would be better." That's an eating disorder misconception. "If I can just get thin, I'll feel more confident, people will like me, my relationships will be better." But it's an abnormal over-valuation of thinness, that being thin will make everything better. "Thin is happy." What you weigh and what you eat is center stage. You can never be thin enough.
How could my child have an eating disorder if she eats meals with us?
Mickley: Some youngsters eat with the family but not the rest of the day and then purge or claim to have already eaten elsewhere.
Isn't weight loss a good thing for athletes?
Mickley: Some people think that the more weight you lose, the better the performance. The reality is that when you aren't eating enough, you burn more muscle mass and impair your performance. You need the energy from food to repair cells and build muscle.
Is an eating disorder a lifelong problem?
Mickley: Sometimes but usually not. People use that as an excuse for not getting treatment or tolerating ineffective treatment. This is a curable illness. More than 50 percent of people are completely cured. Of that remainder, most people get much better.
Is there something more than the eating disorder at play here?
Mickley: Eating disorders commonly exist with other things and aren't just about weight. It's about self-esteem and developing coping skills for life. The eating disorders are a way to deal with those emotional issues. They almost always go with anxiety disorders, self-esteem issues, depression or substance abuse.
Isn't there a medication to help this?
Mickley: Antidepressants can help bulimia. But they don't facilitate weight gain in anorexia. Some antipsychotics may help with anxiety, distorted thinking and low weight. We don't have a pill that treats eating disorders specifically
Is this a real mental disorder?
Mickley: Some people think they do it just to get attention or that it's that they are just being an oppositional teen rather than seeing this as a real mental disorder. Brain chemistry is invisible. It's not like a broken arm. It's hard to see mental pain. It's a real illness, a big time illness that can cause so much pain. Anorexia has the highest mortality of any psychiatric illness and can require long and expensive care.
Should I just ignore it?
Mickley: If you point out your concerns, the person may become defensive and may get angry. But you have to let them know you are worried about them. Give objective feedback. "You look thin." It may not work instantly. But you have to keep trying. I tell parents that if your child has leukemia and just says one day that they don't want to get treatment anymore, you wouldn't just say OK.
People with eating disorders need help in understanding what is going on with them. What you really want to do is nip it in the bud before it gets out of hand.
 Anyone being treated with antidepressants, particularly people being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior. Close watching may be especially important early in treatment or when the dose is changed - either increased or decreased. Bring up your concerns immediately with a doctor.
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External Sources
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National Eating Disorders Association
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The Food and Drug Administration
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This article was reviewed and updated June 2007.
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