Eating disorders are abnormalities in eating behaviour, which occur mainly in adolescent girls and young women in puberty. They are some of the most common chronic health problems in childhood and adolescence. Young men, pre-pubescent children and older women are more rarely affected.
Eating disorders are psychosomatic disorders. This means that they affect both the body and the mind. They are conditions of an addictive nature which can often take a severe course. They can present in “classic” form as anorexia, bulimia or binge eating disorder. But there are also mixed forms and it is often difficult in practice to make a clear distinction since some symptoms are similar. In the course of the condition one form can also merge into another. There are disorders which do not fulfil all the characteristics of anorexia or bulimia. This group of “non-typical” eating disorders occurs frequently in practice. One thing that all eating disorders have in common is: the sufferer’s thoughts revolve constantly around eating or not eating and their figure. Their whole daily routine is organised around this. Simply eating is no longer possible. Eventually the eating disorder governs their whole lives. It destroys feelings, satisfaction, desire, enjoyment and relationships. It damages health and can be life-threatening. That’s why eating disorders must be treated.
People with bulimia appear very well groomed, are generally slim and athletic, and, if anything, slightly underweight. They are often performance-oriented with a tendency to perfectionism. In public their eating is controlled; their binge attacks happen in secret. Sufferers associate these binge attacks with strong feelings of shame and anxiety; they are disgusted with themselves and hate their bodies.
The struggle with food (excessive consumption of food or refusal to eat) can be seen as a substitute for deeper psychological conflicts. The altered eating behaviour represents an attempt to find a solution. It serves as an escape or flight from suppressed needs and unpleasant feelings like stress, fear, despair and loneliness. Eating or starving themselves serves to temporarily dispel their inner tension. A feeling of safety and satisfaction is experienced. In order to maintain this feeling, the behaviour must be repeated. This causes the eating disorder to gain momentum with negative physical and psychological consequences.
Characteristics of bulimia
Please note that the characteristics below can only be indications of bulimia and do not necessarily all occur at the same time; diagnosis can only be made by specialists
Control of body weight:
Experts believe that the development of bulimia stems from the interaction of certain biological, socio-cultural and psychological factors, the significance of which is however seen differently in the various models. Risk factors include, e.g.:
Behaviour learned in social environment:
Temperament and personality:
Consequences of bulimia
The severity of the consequences of bulimia depends on the number of binges. Up to 1% of sufferers die from the disease.
The abnormal eating behaviour can affect the whole metabolism and all the organs. Particularly common effects are: damage to teeth, throat and oesophagus, electrolyte deficiencies, cardiac and vascular effects, impaired renal function, hormone imbalance, stomach and intestinal complaints, impaired perception of hunger and fullness
Obsessive-compulsive disorders, anxiety and depression often occur alongside bulimia; if these conditions were already present before the development of bulimia, this can further their intensify symptoms. In addition in the course of the condition the sufferer comes to devalue themselves more and more and may even come to hate themselves.
In puberty there is a move towards adult life. Adolescents with bulimia miss this phase and thus important development steps.
Self-harming can be a consequence of bulimia, but occurs more often without an eating disorder.
In a severe progression there may be abnormalities in social behaviour. Sufferers are often moody, impulsive or aggressive; their behaviour is contradictory. They may steal food or money, or get into debt to be able to buy food for their binge attacks.
Just as the consequences of bulimia depend on the severity of the condition, so too does the appropriate treatment. In mild cases outpatient treatment may be sufficient, in more severe cases hospital admission or part-time residential care may be necessary. A therapeutic living community can also help. In the case of children and adolescents, parents are usually involved in the treatment.
It can be months or years before full recovery is made from an eating disorder. So it is important that all those involved don’t lose hope or courage.
Each therapy consists of several supplementary components (integrative or multimodal approach). These components include:
Advice centre for eating disorders (drop-in, telephone, Internet)
Evaluation of the situation, provision of information, motivation to treatment
The main focus of treatment for eating disorders. This uses mainly two procedures, the costs of which are reimbursed by health insurers: cognitive behavioural therapy and depth psychological psychotherapy. In addition there is also psychoanalysis, interpersonal psychotherapy and systemic family therapy. You should find out in advance the extent to which your health insurer will assume these costs. Depending on the specific situation either individual or group therapy is used.
Monitoring of weight changes, treatment of accompanying physical conditions
Supportive nutritional therapy
Nutritional advice specifically tailored to eating disorders
Relaxation, body awareness, dance, design, music or art therapy
Self-help programmes for those affected can support treatment, but never replace it. Self-help for relatives offers the opportunity to talk to other parents or relatives.
Confirmation of treatment success; avoidance of relapses
Tips for parents and other relatives
www.hungrig-online.de: The largest German language self-help group for people with eating disorders and their relatives; information, forum, chat
www.bzga-essstoerungen.de: Federal Centre for Health Education; leaflets, advice line (also available on Saturday and Sunday), advice centre addresses
www.nummergegenkummer.de: Federal Association of Child and Adolescent Helplines; telephone and e-mail advice for children and adolescents from professional advisors or adolescents for other adolescents; telephone helpline for parents.
www.bke.de: a wide range of advisory services by the Federal Conference for Parent Counselling for parents and young people, addresses of advice centres, moderated forum, chats.
Beware of the websites Pro Ana and Pro Mia! Pages like these contain advice for persons affected on how to keep losing weight, hide their weight loss or avoid therapy.