Seeking Help for Anorexia, Bulimia and Binge Eating

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Recently Dr. Kathryn Zerbe, professor of psychiatry at Oregon Health and Science University and a longtime expert on eating disorders, took readers' questions on anorexia, bulimia, binge eating and other problems. Below are some of her responses.

See, too, Dr. Zerbe's responses in "Readers Ask: Eating Disorders. The Times Health Guide. Dr. Zerbe will continue to post responses this week, so check the Consults blog for regular updates, and post your questions in the Comments section below.

Middle-Aged, Anorexic and a Mother

I feel less freakish when I read articles such as the above. I experienced a very late onset of anorexia at age 43 I had 4 school age children, was married and had a very successful and fulfilling career as Director of a student learning centre in a private boys school in Tasmania Australia. I felt so alone , a total failure, and worse felt there was nowhere to turn for advice on how to best protect and support my family. That was 5 years ago, I am still struggling and have suffered depression and anxiety in that 5 years. My daughter told me recently that she wished that 5 years ago I had been diagnosed with cancer because then people would have felt sorry for her and would not have made judgements about her mum. It is so scary to go through this experience as a middle aged woman. I felt so much shame.
Joanne

Dr. Zerbe responds:

One of my favorite books to recommend to women in middle life who have an eating problem is Ann Kearney-Cooke's "Change Your Mind, Change Your Body: Feeling Good About Your Body and Self After 40." The book describes people like yourself who feel alone and ashamed of their problem, but who manage to make strides in controlling the anorexia by learning to better care for themselves. Dr. Kearney-Cooke is a psychologist who has worked in the field for many years, and she shares strategies she uses with patients to help them improve self-care, self-esteem and personal power.

That said, it also seems like there is a family issue to deal with along with the anxiety and depression you experience that go hand in hand with late onset anorexia. If you have not already had a full physical workup, by all means, get one. Then get started facing down the stigma of having an eating disorder by entering psychotherapy and unloading some of that shame.

Checking in to Residential Care?

I'm in my 60s and have been struggling with binge eating and yo-yo dieting most of my adult life. One of my doctors recently suggested that I go to a residential eating disorders program. For monetary and other reasons I want to create a program that I can follow with local support. I'm addicted to sugar so I have stopped (for the 100th time) eating it and I am eating much more healthy foods but I have done that before. What can I do to make this a permanent change? One of the reasons I want to do this at home is that my husband is also an overeater and that is the environment I am going to live in.
Brooks

Dr. Zerbe responds:

Entering a residential program is a good beginning for many people because it can jump-start the recovery process. You learn a lot about the disorder, and the professionals in the program have many insights and techniques that aid in recovery.

If that is simply not possible, there is no substitute for beginning outpatient psychotherapy to understand more about yourself and your struggle with binge eating. A good therapist will also provide some excellent suggestions to help you make the change permanent by learning new coping skills.

Overcoming Overeating," by Jane Hirschmann and Carol Munter, and Dr. Wendy Oliver-Pyatt's "Fed Up!: The Breakthrough, Ten Step, No Diet Fitness Plan." Both books are packed with good advice, but there is no substitute for having the support and guidance of an individual therapist and nutritionist to help you make those lasting changes.

When Does Abnormal Eating Cross the Line to Become a Disorder?

Wow, what a complicated subject to put in a short article. I think it's rare to find someone in mid-life and a certain affluence who isn't worried about their weight. Where does it cross the line into a disorder? My brother and his wife seem like a typical example: he's struggled with his weight for decades, she's very thin and has some unusual food habits (vegetarian plus two days a week she "fasts" eating only one meal). Seeing one makes me want to eat fun foods just to make a point, and seeing the other makes me want to eat salads to make a different point.

It seems more rare to me to know someone who exercises in moderation, eats healthfully most of the time, splurges at parties, and stays within a 5 pound range of adult weight. They are the ones who stand out as exceptions. For the rest of us, the obesogenic environment plus the obesity-obsessed media results in a lot of confusion and frustration. Like the recent debate about crust on veggie pie.
RG

Dr. Zerbe responds:

According to the American Psychiatric Association's DSM-IV TR, the diagnostic guide used by mental health professionals in the United States, there have to be a certain number of symptoms of disordered eating to make it a full-blown diagnosis. These include but are not limited to putting excessive emphasis on one's shape and body for self esteem, purging a certain number of times per week, and maintaining a weight that is too low.

However, if the emphasis on body image and eating is interfering with one's quality of life, then it certainly reaches a threshold of being a real problem for the individual. Sometimes unusual food habits like the ones you write about can be a tip-off to an eating disorder, but we would only know for sure by talking with the individual and hoping that she or he will be honest about the extent of her preoccupation with eating, staying slender, or doing anything like over-exercising or purging to keep weight low.

Drugs to Fight Eating Disorders?

wow ... where do I begin? I am 26 years old ... suppose I can't say mid-aged although I feel much older. I've been fighting a battle with bulimia since I was about 16 years old ...

This past fall, a lot of things happened in my life ... lots of change ... and much of it was negative ... I was done ... I couldn't handle another "fat" day ... not one more day of obsessing about food ... hating how I looked and felt ... My doctor prescribed adderall ...

is my eating disorder gone ... sure ... i guess ... but i still hate myself ... my anxiety, because I fear life and losing control of everything around me is still there. I feel like I'm using a big bandaid ... and don't get me wrong ... i love the relief but I feel this huge hole.

Guess I wondered what your thoughts were on amphetamines as a means to treat EDs ...
RL

Additional information:

Health Advice Live Chat Help Health and Wellness: Home Remedies
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Penn State Live University Health Services gives advice on
Live Holistic Alternative Medicine Advice Online, Live Alternative
How to Live a Healthy Life Health Advice Tips Qvisory Blog
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10 Fit Rules to Live By Fitness, Health advice FitSugar

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