eating disorders

   The two commonest types of eating disorder are anorexia nervosa and bulimia. These conditions are characterized by serious disturbances in eating habits and appetitive disorders. Anorexia involves an intense fear of becoming obese. Patients can ‘feel fat’ when they are of normal weight, or even emaciated. The term ‘anorexia’ (loss of appetite) is misleading in the sense that, at the beginning, the patient is as hungry as anyone else who is starving themselves. Anorexia may start with dieting, which then becomes obsessive. Body weight may drop by one-half. The anorexic usually claims to be eating adequately and refuses to acknowledge the emacia-tion that is plain for others to see. Death from starvation occurs in about 10–15 percent of cases, despite the intervention of doctors. The disorder often affects young women with ‘perfectionist’ personalities. The classic anorexic is young (mainly under 30, usually between 14–17), female (95 percent of cases) and from a middle or upper class family. However, the condition is also found in older women and men.

   Bulimia (Greek for ‘great hunger’) is characterized by repeated episodes of ‘bingeing’, that is, eating a lot of high-calorie food followed by self-induced vomiting, or by laxative or amphetamine abuse. These periods are often associated with bouts of depression. Bulimia is frequently found in conjunction with, or as a phase of, anorexia nervosa. This regular gorging leads to guilt and the compulsive desire to be rid of the hated food. The bulimic, unlike the anorexic, functions relatively normally and rarely requires hospitalization, so the disease is not life-threatening. Bulimic behaviour arises from psychological difficulties involving a compulsive desire for perfection and may be exacerbated by poor selfimage, stressful family relationships, or sometimes by leaving home. However, in many cases its cause is undoubtedly a purely physical one, more specifically the impaired secretion of a hormone, cholecystokinin (CCK), that normally induces a feeling of fullness after a meal.

   In the case of both these illnesses it is tempting to feel that an ‘epidemic’ is under way: teenage girls seem to ‘catch’ it from one another. Estimates suggest that up to 1 percent of girls may become anorexic. However, as with previous such ‘epidemics’ (hysteria in the nineteenth century) there are often social or psychological causes which affect many people faced with similar circumstances. The illnesses have been given cult status by the fact that tabloid newspapers have suggested that both the Duchess of York and the Princess of Wales had suffered from them, and this may have made the diseases in a sense ‘chic’. The reasons for suffering from them, though, are complex, specific and relate to individual circumstances.

   Discussion of possible causes for these disorders has focused on women’s position in society, influences from the media, family problems and rejection of adult sexuality. The Victorian ‘separation of spheres’ meant that while men concentrated on the public, the political and the business spheres of life, women were confined to the home and family. Thus they were by and large powerless to influence endemic structures which conditioned their lives. In those circumstances, the only asset over which a woman had a great degree of control was her own body. In such a situation of social powerlessness, distress may be unconsciously expressed in relation to food and body image. Other suggestions have been that, as ‘rules’ have changed, women growing up feel free to seek their own identities. In denying herself, the woman can create a person she can admire, a person who appears to have no needs and no appetites. On the other hand, some adolescent girls resist the impetus to grow up. When anorexia begins in a girl who has just entered puberty, it is sometimes suggested that the illness represents an unconscious desire to remain a child. It has become common on talk shows and in magazines, for example, to blame fashion, newspapers and television for the increase in eating disorders. Waif-like models such as Kate Moss are cited as representing impossibly desirable, almost ‘heroin chic’ images of beauty. Schoolchildren emulate these role models, seen constantly in advertisements, to the detriment of their own health. Young girls are also perhaps more susceptible to peer pressure, which forces them to diet and to become preoccupied with body image. This is evident in advice on anorexia or bulimia which, in response to readers’ requests for help, has become a regular feature of many popular teenage magazine problem pages.

   The number of older women admitting to having these disorders does not necessarily indicate that the diseases are being acknowledged because they are fashionable, but that women now live in a freer society where it is easier to speak out. They feel that, as women’s roles change, they can deal with previously taboo subjects. The Princess of Wales admitted on a Panorama interview that she had suffered from bulimia. This revelation, in conjunction with that of her unhappy marriage, was used as evidence by psychologists who assert that a woman’s social role is a contributory factor to this illness. Anorexia nervosa is resistant to treatment. The principal aim must be to restore nutrition. The anorexic may be hospitalized and fed by stomach tube or through a vein. Because the illness is basically psychological, long-term psychotherapy for both mental and physical recovery is often necessary. However the majority of cases lead to spontaneous complete recovery.

   See also: body size

   Further reading

    Eichenbaum, L. and Orbach, S. (1992) Understanding Women, Harmondsworth: Penguin.

    Katzman, M. and Wooley, S. (eds) (1994) Feminist Perspectives on Eating Disorders, New York: Guilford.

   ELIZABETH STORRY