This one hasn't been graded yet, but I thought I'd go ahead & post it anyways:



There is a dark, dirty secret that affects millions of people’s lives that no one seems to want to talk about: Eating disorders. Though eating disorder awareness is growing, it still has a very long way to go. Eating disorders are stigmatized and misunderstood in our society, and this interferes with treatment and recovery. They are serious diseases that do not discriminate against any gender or race. They can take on many different forms and co-exist with other types of mental illness. By bringing them out of the dark and into the light, we can take away the shame and the secrecy that is so inherent in the illness and help people to get better. Because if there is any myth that needs to be dispelled, it is that people with eating disorders do not get better; that is just not true. People do get better. But first they have to be able to talk about what is wrong before they can start setting things right.

To demonstrate how shameful eating disorders are viewed in our society, I would like to relate an experience I had at a meeting of Alcoholic’s Anonymous (AA). It is not uncommon for men and women to share embarrassing stories at meetings, usually relating the horrible experiences they had with drinking that eventually prompted them to quit drinking. Nor is it unusual for them to talk about other problems in their lives, whether they are about money or work or relationships or whatever else they are struggling with at the time. However, I was surprised to learn that, as one woman put it, “eating disorders are something that we just don’t talk about.”
Bear in mind, this is a group of drunks, many of whom have been homeless, jobless, and penniless. They can tell you about the many times they passed out in a pool of their own vomit after a night of drinking, but they cannot or will not, tell you if they ate today or not. Does this seem a bit awry to you? Because it does to me.

When talking about eating disorders, most people will likely think of anorexia or bulimia, but most do not realize that these are not the only forms food-related pathologies can manifest. Additionally, many may not even know what an eating disorder entails. Anorexia nervosa is characterized by a maintained weight 15% or more below a healthy weight (NHS, 2004). In addition, the individual is obsessed with weight and appearance, restricts food intake in order to lose weight, and is intensely afraid of becoming fat. Bulimia nervosa is a disorder in which a person consumes large quantities of food in short period of time (binging) and then compensates by fasting, exercising, vomiting (purging), or using diuretics, laxatives, or emetics. Binge-eating disorder (BED) is a newly recognized disorder that is similar to bulimia, but without the compensatory behavior (NHS, 2004). It is also more prevalent than anorexia or bulimia – 3.5% of the population as compared to 0.9% and 1.5%, respectively (Hudson, et al). Despite its commonality, BED is also the least researched (Ginsburg, 2007). Indeed, there is a significant lack of research for eating disorders in general, though increasing awareness does seem to be changing this trend. Lastly, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) recognizes that there are eating patterns and food behaviors that do not meet the specific criteria for any of the aforementioned disorders, but that are still problematic enough to be clinically diagnosed as “eating disorder not otherwise specified” (ED-NOS). Unfortunately, eating disorders rarely occur by themselves. According to a February, 2007 study from the National Institute for Mental Health, “people with eating disorders, regardless of the type, often have coexisting mood, anxiety, impulse-control, or substance use disorders,” (Hudson, et al).

Eating disorders affect men and women of all ages and races (Immell). While women are predominantly affected, more and more men are seeking treatment (Liddane). In 2001, experts estimated as much as 10% of all cases were male (Koudsi). Onset is most commonly in the early teenage years for both men and women. Athletes and dancers seem to be especially prone, perhaps because they share a desire for perfection, high achievement, and competition that is common amongst people with eating disorders (Leone). Though once thought to be a problem primarily in Western society, medical professionals are discovering more and more occurrences in industrialized countries such as China and Japan (Hempel).

There has been a small movement to try to use educational programs to prevent the onset of eating disorders, but how effective are these prevention programs? One 1995 study actually showed an increase in eating disorder behavior after a prevention program for female college students (Mann, 1995). Is it possible that instead of frightening or educating these girls to choose healthier eating habits, the presenters actually glamorized the disease? Or did the exposure just normalize the behavior for them? Unfortunately, exposure caused by awareness efforts can have the unintended affect of increasing behavior by making it appear more normal and less taboo. The question is if the benefits outweigh the risks.

In my own attempts at recovery from binge eating, I was exposed to information about bulimia which eventually led to me becoming bulimic. I purchased a self-help book called, “Overcoming Binge Eating,” by Dr. Christopher Fairburn. The book addressed bulimia and BED and contained personal accounts from patients with both disorders. One night, when reading a personal account by a bulimic patient, I noted that she mentioned using her fingers – plural - to make herself purge. I had tried to make myself purge in the past but I had been unsuccessful unless I was drunk. Then I would only make myself throw up if I knew I had already drank too much and would probably be throwing up in a few hours anyways. But I had always used one finger. She used more than one. And just like that, revelation! I immediately put down my book and ran into the bathroom to test my theory. Were two fingers better than one? Absolutely. And thus my already disordered behavior took on a new and exciting form.

Five years and thousands of dollars later, I sometimes wonder, if I had never read that book, would I have started purging? And does that even matter? My eating was already quite out of control before then. I binged and fasted, I binged and exercised, I gained weight, I lost weight, I took diet pills, I did drugs, I drank, and so on. So one could readily conclude that I was already quite susceptible to suggestion, and even if I did not start vomiting, my self-destructive behavior would probably continue or even escalate in some other manner. Looking back, I realize that I had known other bulimics and anorexics in the past, but I was ignorant to their disorders. Nevertheless, their behaviors failed to penetrate my ignorance at the time. I had read about bulimia and anorexia, and even tried to mimic these disorders to lose weight, but the behaviors did not “stick.” It was not until that night at 22 that for some reason - perhaps the planets and stars aligned just so or my neurons and synapses fired in just the right way – that purging made sense, seemed right, and worked.

According to a study conducted by the National Institute of Mental Health, “Eating disorders… represent a public health concern because they are frequently associated with other psychopathology and role impairment, and are frequently undertreated,” (Hudson, et al). This being said, in 2005 the institute provided 75% more funding to Alzheimer’s disease than eating disorders, even though eating disorder affected more than twice a many Americans (10 million versus 4.5 million). The funding it did provide was only for anorexia; there were no reported research funds for bulimia or ED-NOS (NEDA). The lack of funding is indicative of the overall lack of resources for people struggling with this disease. Eating disorders are typically classified as a mental illness, so most insurance companies process the claims that way. However, the illness can take a horrific toll on a person’s physical well-being as well; requiring medical treatment that insurance companies often will not pay for. Treatment is extremely expensive and requires professionals who have had specialized training, which are few and far between. My six-week outpatient treatment program through Providence St. Vincent’s Medical Center cost nearly $30,000. Though the center was in Portland, Oregon, there were patients there who had traveled from all over Oregon, Washington, and Idaho simply because there was no other such facility around for them to get the help they needed.

The need for help is out there, but no one is talking about it because eating disorders are so very taboo. This is unacceptable. The nature of eating disorders is to hide and be secretive. When engaging in this disease, a person does not want others to know how much she is eating or not eating. She does not want family or friends to know that she just threw up, again. This secrecy wrecks havoc on the mind and the body. To make matters worse, society reinforces this secret by condemning models and actresses so afflicted in the tabloids and gossip magazines. Why reach out for help when you’ll be judged as vain, shallow, or desperate for attention? Why reach out for help when the only reaction you will get is disgust or invalidation? For those that have the courage to speak out and ask for help, they find that help is far away and incredibly costly. It is so much easier to just eat another candy bar, run another mile, or swallow another pill and let the disease run its course.

The hope is that by talking about the problem and brining awareness and understanding, the stigma that shrouds this disease will be removed and the easier it will be for people to reach out. Through the classic phenomenon of supply and demand, the more the demand increases for assistance, the more assistance will be supplied, and more people will have the opportunity to recover.

Recovery is possible, but not guaranteed. For anorexia, studies show 43% completely recover, 36% improve, 20% become chronic, and 5% die. Subsequent studies show the mortality rate to be 9.6% (NHS, 2004). Though there has been less research on bulimia, studies have shown that bulimics have a slightly better recovery rate, with 50% recovering completely, 30% improving, and 20% becoming chronic. The mortality rate is unknown. (NHS, 2004). Very little research has been done on binge-eating disorder, but short-term studies show a much better prognosis. A five-year study showed an 88% improvement rate (Fairburn, et al, qtd. in Kriz 112).
My fear and my hope is that the more we talk about eating disorders, the more their prevalence will increase… for a time. This is because I hope that those who have these afflictions will increasingly seek out help and get treatment and get better. I do not want more people to develop eating disorders; I believe that they are already out there, but they are too afraid, ashamed, and hopeless to say anything. The more people talk about this shameful secret, the less shameful it becomes. The more people understand, the more they can offer support. The more support is available, the more people can recover and start living fuller lives; lives that are worth living.



Works Cited
Academy For Eating Disorders. About Eating Disorders. Retrieved June 13, 2008 from http://www.aedweb.org/eating_disorders/index.cfm
Fairburn, C.G., Cooper, Z., Doll, H.A., Norman, P. & O’Connor, M. (2000, July). The Natural course of binge-eating disorder in young women. Archives of General Psychiatry, 57, 659-665, as cited in Kriz 112.
Ginsburg, Shayna M. An integrative group model treatment program for binge eating disorder. Diss. Alliant International University, San Francisco Bay, 2007. Dissertations & Theses: Full Text. ProQuest. 14 Jun. 2008 http://www.proquest.com.ezproxy.apollolibrary.com/>
Hempel, Jessi. "Anorexia Is Becoming a Problem in Asia." At Issue: Anorexia. Ed. Karen F. Balkin. San Diego: Greenhaven Press, 2005. Opposing Viewpoints Resource Center. Gale. Apollo Library. 13 June 2008 <http://find.galegroup.com/ovrc/infomark.do?&contentset=gsrc&type=retrieve&tabid=t010&prodid=ovrc&docid=ej3010003220&source=gale&srcprod=ovrc&usergroupname=apollo&version=1.0>
Hudson, J.I., Hiripi, E., Pope HG Jr, Kessler, RC. The prevalence and correlates of eating disorders in the National comorbidity Survey Replication. NIMH. Department of Psychiatry, Harvard Medical School and Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts 02478, USA. jhudson@mclean.harvard.edu Retrieved June 12, 2008 from http://www.ncbi.nlm.nih.gov/pubmed/16815322?dopt=AbstractPlus
Immell, Myra H. “Eating Disorders: An Overview.” Contemporary Issues Companion: Eating Disorders. San Diego: Greenhaven Press, 2001. Opposing Viewpoints Resource Center. Gale. Apollo Library. 13 June 2008 <http://find.galegroup.com/ovrc/infomark.do?&contentset=gsrc&type=retrieve&tabid=t010&prodid=ovrc&docid=ej3010076204&source=gale&srcprod=ovrc&usergroupname=apollo&version=1.0>.
Kriz, Kerri-Lynn Murphy The efficacy of Overeaters Anonymous in fostering abstinence in binge-eating disorder and Bulimia Nervosa. Diss. Virginia Polytechnic Institute and State University, 2002. Dissertations & Theses: Full Text. ProQuest. 14 Jun. 2008 http://www.proquest.com.ezproxy.apollolibrary.com/
Koudsi, Suzanne. “Men are at risk of eating disorders.” Opposing Viewpoints: Eating disorders. Ed. Jennifer A. Hurley. San Diego: Greenhaven Press, 2001. Opposing Viewpoints Resource Center. Gale. Apollo Library. 13 June 2008 <http://find.galegroup.com/ovrc/infomark.do?&contentset=gsrc&type=retrieve&tabid=t010&prodid=ovrc&docid=ej3010128221&source=gale&srcprod=ovrc&usergroupname=apollo&version=1.0>
Leone, Daniel A. “Athletes are more vulnerable to anorexia than non-athletes.” At Issue: Anorexia. San Diego: Greenhaven Press, 2001. Opposing Viewpoints Resource Center. Gale. Apollo Library. 13 June 2008
<http://find.galegroup.com/ovrc/infomark.do?&contentset=gsrc&type=retrieve&tabid=t010&prodid=ovrc&docid=ej3010003208&source=gale&srcprod=ovrc&usergroupname=apollo&version=1.0>
Liddane, Lisa. "The Growing Number of Adult Men with Eating Disorders." Contemporary Issues Companion: Eating Disorders. Ed. Shasta Gaughen. San Diego: Greenhaven Press, 2004. Opposing Viewpoints Resource Center. Gale. Apollo Library. 13 June 2008 <http://find.galegroup.com/ovrc/infomark.do?&contentset=gsrc&type=retrieve&tabid=t010&prodid=ovrc&docid=ej3010076222&source=gale&srcprod=ovrc&usergroupname=apollo&version=1.0>
Mann, Traci Positive and negative effects of eating disorder prevention programs: A longitudinal evaluation. Diss. Stanford University, 1995. Dissertations & Theses: Full Text. ProQuest. 13 Jun. 2008 http://www.proquest.com.ezproxy.apollolibrary.com/
National Collaborating Centre for Mental Health. Eating Disorders. June 2004. NHS Institute for Innovation and Improvement. Newcastle, UK. Retrieved June 13, 2008 from the NHS Clinical Knowledge Summaries database http://www.prodigy.nhs.uk/eating_disorders/view_whole_topic
National Eating Disorders Association. Facts for activists (or anyone!). NationalEatingDisroder.org Long Island, New York. Retrieved June 13, 2008 from http://www.nationaleatingdisorders.org/p.asp?WebPage_ID=286&Profile_ID=95634