Rehabiliation teaches that once a person is an addict, they will forever be an addict. They will always fight urges to drink, to get high, and to injure. People forget that the same is true for an eating disorder. Once those thoughts- “I weigh too much; I can’t eat until I lose these four pounds”, “I can’t stop eating until I feel okay”, “Why must I look this way?”- taint one’s mind, there is no going back to thinking of food and weight in a logical way. One must fight it, daily, to have a healthy relationship with the nourishment one needs.
Around the world, eating disorders have been a problem for centuries. It is almost hard to say exactly how many people have an eating disorder because some people are too ashamed to discuss their disorder, while others may not even be aware that they have one. Doctors can sometimes treat a patient for an illness that is caused by an eating disorder and may not even be aware that the patient has an eating disorder. It is difficult to diagnose a patient for an eating disorder because of the broad range, styles, and criteria for eating disorders. It is difficult to diagnose a patient because many factors can be related to weight and eating, such as being overweight can be caused by an eating disorder, though it can also be caused by a family lifestyle or cultural influences. Also some eating disorders have specific, mandatory criteria that one must fit in order to be diagnosed as having that disease, therefore it is difficult to make a diagnosis that fits how a person feels and thinks. One may feel he or she is anorexic, meet all the criteria of being anorexic, though they may not be underweight, which is a mandatory criteria in order to fit under the diagnosis of anorexia. This should call for more research and availability to resources to help people learn about and receive treatment for eating disorders.
Despite the fact that it is hard to diagnose, the National Eating Disorders Association has released that at least eleven million people in the United States suffer from an eating disorder, though many more could suffer from “body dissatisfaction and sub-clinical disordered eating attitudes and behaviors” (National Eating Disorders Association). There was also a survey of 1,500 adults throughout the United States conducted in 2005 by the National Eating Disorders Association and Global Market Insite, Inc. that found four out of ten Americans either have known someone with an eating disorder or who have suffered from one themselves, while other studies have found that fifty percent of Americans personally know someone with an eating disorder. Nearly 116 million adults are dieting at any given time, which is about fifty-five percent of the total adult population. A study conducted in 2005 by Neumark-Sztainer found that over one half of teenage girls and one third of teenage boys use unhealthy weight control behavior, such as fasting, vomiting and taking laxatives. According to Mirasol, an eating disorder recovery center, thirty-five percent of “normal dieters” turn into pathological dieters, of which roughly twenty or twenty five percent develop a partial or full eating disorder. These statistic show just how serious people take weight loss and body image, and just how easily dieting can lead into eating disorders.
Even though there are many types of eating disorders, all of them can be just as damaging as the next. The most common eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. Others include pica, Prader-Willi Syndrome, Night Eating Syndrome, Sleep Eating Disorder, Body Dysmorphic Disorder, and two others that physicians will not diagnose because of its lack of clinical guidelines, though have been brought to the attention of several psychiatrists called Ortherexia Nervosa and Bigorexia (Cotter). All of these disorders are severe and may often lead to death if not treated properly. There is also a blanket term for all disorders that do not fit into the categories of anorexia, bulimia, and binge eating disorder. They are called Eating Disorders Not Otherwise Specified, in which the person suffering can show a combination of signs and symptoms of these major eating disorders, though do not meet the full criteria for any one.
Anorexia Nervosa is a compulsive disorder in which the sufferer has an intense fear of gaining weight. The sufferer will also think about food, weight, and exercising excessively. One will typically starve themselves in order to ease tension, anger and anxiety, or just to gain “control” of something in their life. A person with anorexia will view themselves as obese, even though they are typically more than fifteen percent underweight. Anorexia is the third most common mental illness among adolescents. Forty percent of recently identified anorexia cases are in girls from ages fifteen to nineteen. Out of all people with anorexia, only a third will receive mental health care. Without treatment, ten percent of anorexics will die within ten years of contracting the disease, while twenty percent will die within twenty years of the disease starting. Only thirty or forty percent of people with anorexia will full recover from the disease (National Eating Disorders Association).
This French model, Isabelle Caro, helped run an ad campaign to raise public awareness of anorexia. In this picture, she is said to be only fifty-nine pounds. Caro died at the age of twenty eight from anorexia on November seventeenth of 2011..
Anorexia nervosa has the highest death rate of any psychiatric illness. This includes major depression. For females between the ages of fifteen and twenty four, anorexia is twelve times more likely to take their life than anything else. Even if a person with anorexia does not die, many health issues can arise in them because of the disease. Extreme damage to the heart can occur, including heart muscle shrinkage, slow or irregular heart beats and possibly heart failure. Kidney issues can also occur, including kidney stones or failure (U.S. Deparment of Mental Health). Problems with the digestive track are extremely common, along with muscle deterioration and lack of bone strength.
Bulimia Nervosa is characterized by binge eating and purging. This includes eating a large amount of food, most commonly sweet or salty, unhealthy, foods, and then either throwing the food up, taking laxatives to flush their system, or exercising excessively to “purge” their body of the food they consumed to prevent weight gain. The amount of women age ten to thirty nine who suffer from bulimia tripled between 1988 and 1993. Three to five percent of women suffer from bulimia nervosa sometime in their lifetime. Five and one tenth percent of women in college suffer from bulimia nervosa. Unlike people who suffer from anorexia, people living with bulimia are harder to spot by appearance alone. Most individuals with bulimia stay around a normal weight for their age and height, but there are some physical signs such as abrasions on knuckles or swollen cheeks.
The mortality rate for bulimia nervosa is four percent, and the suicide rate for this disease is significantly larger than any other eating disorder (Crow). If treated, the mortality rate for bulimia is three and nine tenths percent. Some of these deaths are even created because the sufferer has choked while forcing themselves to vomit. Health issues that bulimia can cause are electrolyte deficiencies, laxative dependency, and emetic toxicity. It can also cause teeth erosion and irritation and tears of the throat, esophagus, and stomach because of the excessive amounts of purging in which the bulimic individual partakes (U.S. Department of Mental Health).
Binge eating disorder, or compulsive overeating, consists of a person eating past the point of being full. This mostly happens with a trigger food; the people with this condition will uncontrollably eat until they feel guilty. This then causes them to try to control their diet by extreme dieting, exercising, or purging, such as in bulimia nervosa, though these extreme ways to lose weight are often short lived and are overpowered by the person’s uncontrollable amount of eating. People with binge eating disorder are usually overweight because they eat so many calories for which their body has no use. About two percent of the American population is effected by binge eating disorder. With binge eating, there is a fifty percent remission rate following cognitive behavioral therapy, though that means fifty percent of patients do not recover from this disease.
Pica is a disorder related to compulsively craving non-food items. This can include chalk, paint chips, glue, coffee grounds, and more. This can be caused by mineral deficiencies, or psychological disturbance. Pica can cause “lead poisoning, malnutrition, abdominal problems, intestinal blocks, hypokalemia, mercury poisoning, (and) phosphorus intoxication” (Cotter). These can eventually lead to death if not treated properly.
Prader-Willi syndrome is a congenital condition that is caused by an abnormality in a person’s genes or hypothalamus. A person with Prader-Willis syndrome has a large appetite. A person with this disease will even eat pet food or rotten food in order to calm his or her appetite. This appetite can cause obesity, which can lead to type two diabetes. Other problems associated with this disease are abnormal growth, speech impairments, delayed motor development, and poor muscle tone. Though this disorder is stressful and emotional, it is rare and the life expectancy of someone with Prader-Willis is normal if his or her weight can be controlled.
Night eating syndrome is characterized by the person waiting to eat until later in the day, and binge on food when this person does eat. They typically do not eat more than the recommended amount for a normal meal in one sitting, though eat frequently after noon. Most people with night eating syndrome have difficulty falling and staying asleep. This can cause obesity and depression.
Sleep eating disorder is typically known as a sleep disorder, though it involves episodes of reoccurring sleep walking. While sleep walking, the individual will usually binge on food high in sugar or fat (Cotter). The individual is normally obese and is not in control of his or her eating, because they eat while they sleep. This can be caused by anxiety, stress, and exhaustion.
Body dysmorphic disorder is an obsession with a defect in ones visual appearance. This can be a real defect, non-delusional type of body dysmorphic disorder, or one that the person believes is there, though actually isn’t, or isn’t as bad as he or she believes, delusional type of body dysmorphic disorder. Most people suffering from this disorder go through compulsive rituals to hide or get rid of the defect. Some go as far as to attempt their own surgery or commit suicide. Most with this disorder become socially isolated because of their fear of judgement. Most patients find no relief in behavioral therapy, but Serotonin Reuptake Inhibiter Anti Depressants have seemed to control some symptoms (Phillips).
Orthorexia nervosa is composed of an obsession for a “pure” diet so large that it interferes with a person’s life. If the individual suffering eats something they consider “unclean” they will discipline themselves with a stricter diet and by fasting. This isn’t to be confused with a healthy eater. The only way to be diagnosed with Orthorexia is if the diet negatively effects the person’s way of living and causes extreme distress to them.
Bigorexia is the opposite of anorexia. It is mostly found in body builders who believe themselves to be too small and wish to increase their muscle mass. It is also known as muscle dysmorphia (Cotter). People who suffer from this disease are more likely to use steroids and to stay on a strict protein diet which can cause kidney failure. They also lift weights obsessively, to the point that it can cause extreme harm.
With eating disorders not otherwise specified, or EDNOS, there are a wide variety of diagnoses that fit. With this term, it can mean anything from having all but one symptom of anorexia or that someone suffers from anorexia and bulimia, which is sometimes called bulimerexic. A person who repeatedly chews and spits out large amounts of food can be diagnosed as having an eating disorder not otherwise specified, he or she could also be subject to purging disorder, where a person purges after eating small amounts of food. Studies for EDNOS are rare, because of how wide the types of eating disorder not otherwise specified vary. They are difficult to diagnose properly, therefore it is hard to find specific treatment. It has been found that cognitive behavioral therapy benefits the patient who binges and purges. Therapy is usually used with nutritional counseling and antidepressants, though no patient is just alike, therefore they must be given individualized attention.
Many of the disorders discussed above fall into the category of an EDNOS. These diseases can be extremely harmful, and are often misdiagnosed because of the misconception that anorexia, bulimia, and binge-eating are the only eating disorders. If people are aware of eating disorders not otherwise specified, they usually assume that these cases are not as severe as anorexia or bulimia, though this is not the case. All can cause irreversible damage to the individual suffering from the disease. In fact, according to a study help in 2009, the mortality rate of individuals with eating disorders not otherwise specified were similar to those with anorexia. The actual number is five and two tenths percent mortality rate. People with EDNOS can have all the medical problems that individuals with any other eating disorder have, such as heart failure, low blood pressure, vitamin deficiencies, and disruption of hormones. Individuals suffering from EDNOS also usually have significant mental and emotional disturbances.
Below is a chart comparing the three types of eating disorders in their mortality rates from all causes, paired with a mortality rate from suicide. The following chart shows that while some disorders may be more known and discussed throughout the media, they all are extremely dangerous and harmful to the individual that they affect.
A chart taken from the American Journal of Psychiatry showing the findings from a study of mortality rate of those suffering from eating disorders, with a focus in bulimia nervosa and eating disorders not otherwise specified in 2009
Without treatment twenty percent of people suffering from a serious eating disorder will die from it. With treatment, two or three percent who suffer will die. Despite the fact of how dangerous and harmful these diseases are, most insurance companies still do not cover the costs of treatment. Though insurance companies may say they will provide coverage for some treatments for eating disorders, they may only provide enough money to cover a ten day stay in inpatient recovery, when someone is recommended to stay for months. There are loopholes to get around and to help their chances of receiving coverage, though it is an extremely long process and may not work, such as the people suffering can contact their insurance company and describe their diagnoses, how long their care will last, and what type of care they will be receiving. They can also contact their employer to try to convince them to switch insurance companies, which may or may not work, and if it did would take time to go through. If none of this works, the individual may figure out how much of their care that he or she can pay for and then contact his or her insurance company and ask them to cover the rest. Most, if not all, of these loopholes are theoretical and may not change anything. Eating disorders are extremely serious and can be expensive to treat, though it seems that not many insurance companies believe this to be the case.
Treatment costs in the United States typically costs between five hundred and two thousand dollars per day. It is recommended that a person with an eating disorder receive three to six months of inpatient care, which can cost up to one hundred eighty thousand dollars. Outpatient care can cost more than one hundred thousand dollars, which includes therapy and medical monitoring. With little help from insurance, most people cannot afford to get the amount of help they need to overcome an eating disorder, with only one in ten people with an eating disorder receiving treatment. From that small group, eighty percent do not get the amount of recommended care because they leave weeks earlier than they should.
Only a third of patients recover after one set of treatments, a third suffers from the disease multiple times, even after “recovery”, and a third do not recover during treatment. Multiple stays at hospitals are extremely common in patients with eating disorders. With how dangerous eating disorders are, and the amount of people that they effect, it is ludicrous that they are funded with such a small amount compared to most other psychological diseases. Even with the small amount given for funding, it is only provided for research and treatment for anorexia nervosa, which is only one of many eating disorders. With other major eating disorders affecting people, there should be more funding for all eating disorders, not just the most known or discussed in the media. As the following chart shows, funding is relatively low for anorexia nervosa, while disorders that affect a lesser amount people receive hundreds of millions of dollars.
The above is an insert published by the National Eating Disorder Association.
With seven million dollars provided for at least ten million affected people, that only leaves seventy cents for each affected person, while schizophrenia effects two million two hundred thousand and is give two hundred forty nine million dollars in funding, which leaves one hundred fifty nine dollars for each individual. With how expensive research and treatment are it would be impossible to do anything with seven million dollars to help on a large scale. Eating disorders are slowly killing people, and something needs to be done about it.
With how dangerous these diseases are, it is ludicrous that insurance covers so little and that the government does not force insurance companies to pay for more, or that the government does not provide more funding for research and treatment. Over twenty four million people are affected by an eating disorder yet they receive little funding comparatively speaking. Eating disorders can kill twenty percent of the people that it affects, yet they seem to be almost forgotten.
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