ANOREXIA AT THANKSGIVING?

Victor Bloom MD

Grosse Pointe Park

Thanksgiving is turkey-time--- stuffing, mashed potatoes, cranberry sauce, sweet potatoes and pumpkin pie, maybe with some whipped cream. To those of us who love to eat, it is a joyous time. But believe it or not, there are a growing number of people who get sick to their stomach at the thought of stuffing themselves. They are afflicted with anorexia nervosa, a debilitating and devastating condition in which a person could literally starve themselves to death. Somehow he or she, (mostly 'she') is repulsed at the thought of a millimeter of fat on her bones and is trying to transform her body into the shape of 'Twiggy', or the present-day models who are almost six feet tall and weigh under 120 pounds. These Vogue models have become the standard of fashion and beauty for some, especially in America, but also around the world. These anorexics maintain the belief that such a body is necessary for approval and love; they want to be 'attractive', but ironically and tragically, they may get to look like concentration-camp survivors.

On the other hand, bulimics may join in the holiday festivities with varied body sizes and stuff themselves on all the goodies, but then secretly retire to throw up, so as not to gain any weight. Excess purging can lead to severe mineral imbalances and stomach acid can cause erosion of teeth. There is terrible guilt associated with eating and conflict about ingesting and purging.

These are now classified as 'eating-disorders' and research has shown that there is usually a family history of mood disorders, which indicates a neuro-chemical imbalance which is often hereditery. It used to be believed that these conditions were due to childhood emotional problems, but experience has shown that psychotherapy alone is seldom effective in curing these conditions. Nowadays, psychotherapy is conducted in conjunction with family therapy, medical and nutritional care, support groups and periods of residential or inpatient psychiatric treatment. Anti-depressive medication is also often helpful, combined with cognitive as well as emotive therapies.

If you have a friend or a relative with an untreated eating disorder, by all means advise him or her to seek professional help. Much is available and it is now more effective than ever, with growing experience of mental health professionals and availability of the newer medications. Anorexics can be spotted by the evident underweight and bulimics by the behavior of 'binging', in which the person will consume huge quantities of candy, cookies or ice cream. They might even consume large quantities of vegetables to provide a full if not stuffed feeling, to produce the impetus for vomiting.

Eating would seem to be the most normal of human activities, and it is hard to believe the extremes to which persons with eating disorders will go, but for some reason these people become fixated on food and its connection to body image, size and shape. Other eating disorders include those who are grossly obese, another life-threatening condition. In this case, people become addicted to food, just as others may become addicted to alcohol, cocaine, heroine or nicotine. Ingestion produces a short-term feeling of relaxation or relief, which is highly prized, and longterm morbidity is overlooked or denied. These people are in need of intensive medical care and longterm supervision.

The best way to deal with these people is to give firm and repeated advice with a compassionate and nonjudgmental attitude. Their problematic behavior should never be the source of cruel joking. Avoiding the subject altogether is 'enabling' of the troubled behavior and does no good. The problem will not go away by itself.

Eating disorders are quite common when one includes the large percentage of overweight Americans. Most of us rationalize our excesses and try to work off the extra weight with exercises at home or in gyms. It is a long struggle and a delicate balance, but for the time being, enjoy Thanksgiving. We are lucky to live in a land of plenty and peace. We have a lot to be thankful for.