Anorexia and bulimia are eating disorders on the increase. Although the conditions are generally associated with girls there is evidence that boys suffer too. Depression is also associated with these eating disturbances and the risk of suicide in girls with anorexia is estimated to be 20 times higher than in young people on average.
The treatment of anorexia presents a number of challenges. The focus of attention is quite naturally related to appropriate dietary needs but there is increasing awareness of the need to treat the despondency that so frequently accompanies anorexia.
A typical scenario begins with dissatisfaction with body shape and possibly media influences over the ideal body shape. The initial targets are cutting out sweets and carbohydrates. Any food containing fat is rejected. This rejection of food is replaced by picking at acceptable alternatives. Very often the person starts exercising. Soon they begin to look thin and eventually gaunt. Menstruation stops and sensitivity to cold increases as body fat and muscle waste away. Faced with such changes and evidence of weight loss is insufficient to stimulate change. From the perspective of the person with anorexia, they remain overweight.
Bulimics mix compulsive overeating with compulsive vomiting and sometimes even switch between bulimia to anorexia. Like anorectics, people with bulimia are fixated on body weight and appearance and seem unable to interpret body signals correctly.
Depression is fuelled in various ways. The initial reason for a dramatic changes in diet is directly associated with despondency over body image. As malnutrition sets in, the biochemical imbalance that results further feeds depression. Anorexia is also a hidden disease. The person goes to great lengths to hide their problem. They do not share their concerns and their sense of isolation and personal blame feeds depression further.
In anorexia and bulimia the risk of depression is high. To date, treatment tends to focus around a package of measures tailored to individual needs. As malnutrition is directly associated with depression, focus is always on the restoration of diet. In a more general sense, medication, family therapy and individual psychotherapy or cognitive therapy are used in combination, with encouraging results. Standard SSRI medications have something of a mixed result, with some people appearing to benefit and others not. In young people the prescribing of drugs like fluoxetine (Prozac) may not be advised due to concerns about increases in suicidal ideation.