When a fourteen-year-old patient was seen recently in my office for her annual checkup I was momentarily stunned at her weight loss. Mom confirmed my suspicions by proclaiming that Janice was starving herself. "She exercises at least two hours a day and keeps saying that she feels 'fat'." In reality, she looked like skin and bones.
Mom justified her responsibility by offering that she and her husband worked hard to keep the family close. "I supervise all of her activities and friends. It's so difficult to raise children these days, but I really don't know what to do about this."
One must remember that feelings about food and eating often are complicated during adolescence; they become intensified by youngsters who have eating disorders. It appeared that Janice was suffering from a condition called anorexia nervosa. This condition means "appetite loss of nervous origin" and usually begins in early adolescence. Symptoms, however, have been seen in children as early as nine years old, and most of the sufferers are female. Anorexia in a girl causes her body weight to fall as low as 15% below normal. Menstruating usually ceases and she often develops symptoms of starvation. This includes dry skin, brittle nails and hair, constipation, anemia, loss of bone mass, or swollen joints. Sexual development frequently is delayed or even arrested.
The young patient often feels fat, although in reality she is obviously quite thin. She does not see her eating or exercising as anything abnormal. Surprisingly, the actual loss of an appetite is a rarity. More than likely she is obsessed with food and enjoys preparing it for others. Some females are known to hoard food. Some will compulsively cut it into tiny pieces, or stealthily throw it away.
Fortunately, anorexia nervosa is rare; its prevalence in the general population is about one percent. Bulimia nervosa, which means "oxlike hunger of nervous origin", is more common than anorexia. This condition may strike young females who are already anorexic. Symptoms of bulimia are two or more episodes of binge eating each week for at least three months. Rapid consumption of large amounts of food-- commonly, ice cream, chips and other "junk foods" describe binge eating. The victim immediately causes herself to vomit, or uses laxatives or diuretics--anything to get rid of the food she just consumed. Between binges she may compulsively exercise or go on strict diets.
There lies a fine line between dieting and an eating disorder which would require medical intervention. We have seen some girls who diet and lose weight quickly, but still menstruate. Some binge without using laxatives or diuretics, and even eat normally between binges.
Many psychological theories have been proposed in order to understand the cause of anorexia and bulimia. Ideas about the personalities of those females who suffer from these conditions are on-going studies. Their family dynamics have been offered as contributing to the development of eating disorders.
These victims need to be evaluated by their doctor in order to rule out any physical abnormality. Hormone imbalances or electrolyte abnormalities can occur in advanced cases, and are potentially quite serious. It is often imperative to refer the patient to a physician who specializes in eating disorders. An aggressive individual and family program can be initiated, and family therapy is often very important in the treatment of eating disorders.