The Changing Face of Anorexia:Starving For Perfection

Anorexia nervosa and other eating disorders pose new diagnostic and treatment challenges as they affect younger and older patients.

Article By: Kathleen Phalen Tomaselli,
AMNews correspondent.

It was a daily menu of gum and tea sprinkled with 20 or so over-the-counter diet and water pills, 10 laxatives and six hours running on the treadmill. A few times a week, she would cut on her body with knives she kept taped under chairs; a release of pain, anger and starved emotions. At night she would lie awake, agonizing about how she could stay committed to this regimen.

"I'd eat one meal a week if I had to," says Sherri Crowl, now 40, of Edinboro, Pa. "My eating disorder started when I was 8." After 30 years, Crowl was diagnosed with anorexia nervosa. "I kept thinking, if I could be thinner, people would be in awe of me and want to be that size, too."

With eating disorders often passed off as a phase, intervention can be delayed or nonexistent. "Primary care and family physicians are so underutilized in getting people into treatment," says Kimberly Dennis, MD, a psychiatrist and medical director at Timberline Knolls, a residential treatment center near Chicago that helps women with eating disorders, addictions or other destructive behaviors. "Denial is huge, and a high-functioning intelligent woman who is not maintaining a healthy weight is easier to let go. Many physicians don't know what to do."

Take Crowl. When her heart had nearly stopped beating, she assured friends, family and medical professionals she was healthy. When she finally sought help, the doctor who did the admitting tests said her heart was beating so slowly that without treatment, she would die in a month. "I was shocked," she says, explaining that she still kept thinking that she exercised six hours a day -- of course she was healthy.

Her story is not so rare. Bodies of all ages fade into wisps of what once was, and anorexics are dying at a rate of 10% to 20% from complications of starvation or from suicide. Still, skeletal frames continue to sashay down runways; extreme- makeover programs highlight body perfection; and reality shows reward weight loss and excessive exercise. In the war on obesity, thinness has become the hallmark of success. "There's this continued glorifying of unhealthy and unnatural images," says Harry A. Brandt, MD, a psychiatrist and medical director of the Center for Eating Disorders at the Sheppard Pratt Health System in Baltimore.

To further complicate diagnosis, anorexia is no longer only a disorder of white teenage girls. It affects all ages, races and cultures. It even can cross gender boundaries. About 15% of anorexics are men. "Men are underdiagnosed and undertreated," Dr. Brandt says. "If a man loses weight, the physician does a mega medical work-up. It couldn't possibly be an eating disorder."

The disorder's new faces

The face of anorexia is changing, says Brenda Woods, MD, a family physician and director of primary care medicine at Remuda Ranch in Wickenburg, Ariz., an inpatient and residential treatment facility for women and girls, with facilities in Virginia and Arizona. "We are seeing age spectrums different from what is expected. We've had a 400% increase in calls by women older than 40 and a 700% increase in the child population, age 7 and 8. That's why we started a child program."

Many anorexic children can't verbalize why they don't eat or why they will eat only certain foods at certain times. "Maybe they had a previous episode of choking and that scared them, or somewhere they developed a fear of becoming fat," Dr. Woods says. "It's very common. If Mom is always on a diet and not eating what the family eats, the child will mimic that behavior."

10% to 20% of anorexics die from complications of starvation or suicide.

All the while, the pressure to be thin reaches younger ages. According to the National Center for Health Statistics, 51% of 9- to 10-year-old girls feel better about themselves if they are on a diet. Forty-two percent of first- to third-grade girls want to be thinner, and 81% of 10-year-olds are afraid of being fat.

"Extreme dieting sets up a competition among kids," Dr. Brandt says. "There's the cohort effect. One or two start dieting, and there is a competition to be thinner."

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Sources:http://www.ama-assn.org/amednews/2008/05/05/hlsa0505.htm
picture: http://files.blog-city.com/files/aa/2370/p/f/3623019mw.jpg