Anorexia and Bulimia

Upcoming ritual holidays – 5/21 full moon: 5/30 Memorial Day: 6/6 D-Day, the invasion of France in WW II (Nazi): 6/19 Fathers’ Day (US and Canada): 6/20 is both a full moon and the summer solstice

Prior posts on eating disorders – 4/10 Eating Disorders (Introduction): 4/20 Over-Eating: 5/10 Ritual Abuse Issues and Eating Disorders.

Let’s get oriented with some definitions:

Anorexia: “lack of appetite.” Modern Latin, from the Greek “anorexia:” the prefix “a,” without, and “orexis,” appetite, desire. First used in the 1590s. Anorexia nervosa was coined by William Gull in 1873 to mean “emaciation as a result of severe emotional disturbance.”
Paraphrased from the Online Etymology Dictionary,

Bulimia: “compulsive overeating usually followed by purging” Modern Latin, from the Greek “boulimia:” “ravenous hunger” (literally “ox-hunger”) from the prefix bou, (from “bous” ox) and “limos” hunger. The word entered English as bulimy in the medical sense in the late 14th century.
Paraphrased from the Online Etymology Dictionary,

Both these words are usually used to denote an eating disorder, but they can also be symptoms of other conditions. Anorexia can be a side effect of chemotherapy or extreme emotional distress. Prader-Willi disease is present at birth and makes children eat uncontrollably because they always feel hungry. Bulimia can be caused by poorly controlled blood sugar in diabetics.

Anorexia is the most dangerous of the eating disorders, with more fatalities than any other psychiatric condition. It is frightening for friends and family – and sometimes doctors and therapists – who feel helpless to do anything for the person with the condition and are panicked that the person may die.

Basically, it is an overwhelming obsession with food coupled with a distorted body image and an intense fear of becoming fat. The person believes they are fat when they actually are seriously underweight or emaciated. This misperception sets off a vicious cycle, increasing the resolve to diet stringently and strengthening the obsession.

Food is often categorized as “good” or “bad” and only very small amounts of “good” foods are allowed. Food may be weighed and charts of calories, grams of protein, carbohydrates, and fats logged meticulously. Some people attempt to manage their weight by depriving themselves of nourishment, while others turn to purging or excessive exercise. Either form of anorexia takes over the person’s life.

Anorexia is the most common cause of death among women aged 15 to 24, and affects between 0.5% and 3% of the general population. Men make up about 25% of anorexics. Some studies say that between 5% and 20% of anorexics will die of the condition, sometimes years after they have started eating normally.

Anorexia takes a huge toll on the body. Bone loss can occur after only six months from too much cortisol (the stress hormone), low levels of estrogen, and not getting enough calcium and vitamin D. Men experience bone loss from all the same factors, except that they have low testosterone, rather than low estrogen. Bone loss is irreversible without medications.

Heart damage occurs quickly, too. Starving yourself burns not only fat, but muscle tissue, and the heart is a muscle. The heart gets smaller and weaker, and, again, the harm is irreversible. The immune system is weaker, and so you are more apt to get infections, which are harder to fight off because you have a low white cell count.

And then there is lack of menstrual periods, thinning hair, feeling cold and tired, and messed up blood electrolytes.

Any deviation from the self-imposed dietary rules causes anxiety, shame, and guilt. There is also intense shame because of the misperception of being overweight or obese. Feeling fat may lead to wearing clothes that completely cover the body, avoiding social situations, and self-loathing.

Sometimes people can’t tolerate constant starvation and break down and binge. Sometimes binges occur periodically, sometimes anorexia is replaced by bulimia. Both disorders are horrible to live with, narrowing your world and sucking all pleasure out of life.

Bulimia is characterized by recurrent episodes of binge eating followed by efforts to eliminate the food eaten (vomiting, laxatives, fasting, etc.) This isn’t a now-and-then occurrence, like at Thanksgiving; it takes place on average twice weekly for three months or more.

There are two types of bulimia; purging and non-purging. With the purging kind, the person tries to eliminate all the calories by induced vomiting, laxatives, or enemas. Non-purging bulimics compensate for their binges by fasting or excessive exercise.

The prevalence of bulimia is said to be 2% to 3% of the general population and can be as high as 10% in certain groups, such as college-aged women. It occurs in 2.3% of white women but in only 0.4% of black women – probably because the studies are done on white middle-class women. Males have not been studied as much, but it appears that about a quarter of bulimics are men.

It is relatively easy to keep bulimia a secret. Many people are of normal weight, or even overweight or obese, so an eating disorder never crosses family or friends’ minds. Both binging and purging is done in private, as both are accompanied by intense guilt and shame at losing control. And the longer it goes on, the lower a person’s self-esteem, the greater the feelings of shame, and the more effort is put into keeping it a secret.

Bulimia may be an effort to contain PTSD, anxiety, or clinical depression, and the rate of substance abuse is high, especially of diet pills and stimulants. About 30% of bulimics are also alcoholic, and other forms of self-injury, such as cutting, are often seen.

Like anorexia, the damage bulimia can do is extensive. If ipacac, which is toxic to the heart, is used to induce vomiting, heart failure may result. Vomiting can erode enamel on the teeth, make the salivary glands swell visibly, and make small bleeding tears in the esophagus. About half of bulimics stop menstruating or have irregular periods.

Cognitive-Behavior Therapy, alone or with antidepressants, is recommended for treatment of bulimia. If the binging and purging has been going on for a long time or occurs frequently, it is harder to treat and there are more relapses. The Twelve Step program, Over-Eaters Anonymous, welcomes anorexics and bulimics as well as over-eaters – it should really be called Eating Disorders Anonymous.

Finally, the eating disorders bibliography at lists resources. The website Something Fishy at is especially helpful.

Eating Disorders

New Book! Jade Miller’s “Attachment and Dissociation: A Survivor’s Analysis” in e-book form. About intergenerational dysfunctional attachments and Jade’s healing process. (Jade is the author of “Dear Little Ones.”)


Now for eating disorders. This is a huge subject and I will break it up with posts on a couple of other topics. (Like, say, Mothers’ Day, which doesn’t bother me a bit. Yeah.) Think of this post as the introduction; there is nothing about alters, ritual abuse, or healing in this section, so be patient. And there won’t be lots of statistics in the other sections.

I was at the International Society for the Study of Trauma and Dissociation (ISSTD) conference the beginning of April this year and went to two very good workshops on eating disorders. One was “The Body Remembers: The Brain Reacts: Clinical Applications of Current Research on the Underlying Connections between Eating Disorders and Trauma” by Norman H. Kim, National Director of the Center for Change and Director of Reasons Eating Disorder Center. The other was “Trauma, Dissociation, and Eating Disorders: When No Body is Home” by Debbie Cohen, who is on the Faculty of ISSTD. Much of the material in this post comes from those workshops.

Let’s start with some definitions. Anorexia is limiting the intake of food to the point of significantly low body weight, along with the fear of becoming fat and the distortion of body image to seem heavier than one is in actuality. Bulimia is the periodic out-of-control eating of large amounts of food followed by attempts to prevent weight gain by vomiting, using laxatives, or excessive exercising. Anorexia can be followed by periods of binge eating, or bulimia may occur alone. Binge Eating Disorder is the periodic out-of-control eating of large amounts of food, but without attempts to prevent weight gain. It is accompanied by shame, embarrassment, and attempts to hide episodes from other people. Steadily eating large amounts of food isn’t currently labelled an eating disorder, even though it probably should be.

There are a lot of misconceptions about eating disorders. A big one is that they are caused by society and the media, with all the hype about weight, dieting, and the desirability of thinness. The emphasis on weight makes people dissatisfied with their bodies: 42% of girls in first to third grades want to be thinner; 81% of ten-year-old girls are afraid of being fat; and half of ten-year-old girls have dieted. But the rate of eating disorders has not changed. We are more miserable and pour billions of dollars into the diet industry but the prevalence of eating disorders has not changed.

Another misconception is that it’s an illness of rich white girls. However, that’s who gets studied and therefore that’s who gets the attention. The rates are the same for Afro-American and Latina girls.

Men, too, suffer from eating disorders. Of all people with eating disorders, about 25% of anorexics  and 36% of bulimics are male. Men tend to get overlooked because eating disorders, like depression, are seen as a women’s problem. There now are some in-patient and out-patient treatment programs specifically for men and hopefully there will be more resources in the future.

Family and twin studies suggest a genetic component to anorexia and bulimia. Anorexia is seen in 0.3% to 0.7% and bulimia in 1.7% to 2.5% of women in the general population. Yet they are 7 to 12 times more likely in relatives of those with eating disorders, even if relatives do not share a common environment. Twin studies show that genetic factors seem to “kick in” at adolescence and that there seems to be something in the environment that triggers the onset of eating disorders.

So if you have an eating disorder, and lots of your blood relatives do, too, it may be genetic. Not your fault, just plain bad luck. Of course, if it wasn’t genetic, it still wouldn’t be your fault.

Eating disorders, especially anorexia, are very, very serious. In females 15 – 24 years old, the mortality rate from eating disorders is 12 times higher than the mortality rates from all other causes of death combined. And, if you have an eating disorder, it is reported that your chances of dying from this illness at some point in your life range from 5% to 20%, depending on the study.

The environmental trigger typically seems to be a trauma, such as sexual abuse or bullying. A study described in “Anorexia Nervosa and Bulimic Disorders: Current Perspectives,” edited by G.I. Szmukler, P. D. Slade, and P. Harris, pp. 357-61 showed that almost two-thirds of women patients who entered a London eating disorders clinic between 1982 and 1984 reported sexual trauma in childhood or adolescence. This did not, of course, include anybody who had amnesia for the abuse.

One last bit of information: there have been two surveys (that I know of) looking at the prevalence of eating disorders in survivors of ritual abuse and other forms of extreme childhood trauma. Both were self-reporting and open to any survivor who wished to participate. One was conducted by Survivorship and the other by the Extreme Abuse Survey. 60% to 65% percent of survivors said that they had an eating disorder, while less than 20% reported that they were alcoholic and/or drug-addicted.

I’d like to end this post by pointing out that eating disorders are hard to treat, the effects of sexual abuse are hard to treat, and the two together are even harder to treat. Or to live with, for that matter!!! Add in amnesia, dissociation, ritual abuse, and/or mind control … well, nobody said it was going to be easy.