Q. For the past few months, all of the TV programs have been talking about the problems of people being overweight and how this is a bad problem around the holidays. But my daughter has the reverse problem.
Shes too thin, and she just wont eat enough to gain any weight, even though she will stuff herself sometimes. Ive heard that some people throw up on purpose, but I dont know if she does that. Please help me understand. A.N., Milford, N.J.
A. It sounds like your daughter has an eating disorder. The two major eating disorders are anorexia nervosa and bulimia nervosa. Most people with these eating disorders are young, white, middle- and upper-class women overly concerned about body weight and shape. These disorders can, however, afflict members of both sexes and all races and classes.
Anorexia nervosa is characterized by a distorted body image, an extreme fear of being overweight, refusal to maintain a minimally normal body weight, and the absence of menstrual periods.
Anorexia nervosa is a very serious psychiatric and medical problem, but you havent provided enough information to make this diagnosis. For example, you didnt mention whether she is trying to lose weight, even though she is so thin, or whether she is obsessed about her body appearance.
The behavior associated with bulimia nervosa seems to be closer to that of your daughter. Bulimia nervosa is usually characterized by frequent, uncontrollable bouts of binge eating, followed by inappropriate compensatory behavior known as purging. Purging includes induced vomiting and use of laxatives and diuretics. Other ways to counteract the effects of binge eating involve rigorous dieting and excessive exercise.
Usually, a person with bulimia induces vomiting to relieve the physical discomfort of overeating as well as to alleviate the fear of gaining weight. Sometimes, however, the vomiting can become a goal in itself, and the person will binge in order to vomit or will vomit after eating a small amount of food.
Bulimia is different from anorexia. In bulimia, the body weight tends to be within the normal range. People are more aware of their behavior and are more likely to seek treatment (this is good because bulimia is more difficult to detect by others). People with bulimia are more outgoing and impulsive, but they are also more prone to depression. Episodes of binge eating can often be accompanied by a sense of lack of control and symptoms of depression.
The most common medical complications are dehydration and abnormal levels of sodium and potassium. Changes in bone and the brain are often significant. Repeated vomiting can play havoc with the digestive system, from loss of dental enamel to changes in the walls of the intestine.
Bulimia and other eating disorders can be mild or very severe psychological problems requiring psychotherapeutic treatment. This means supportive care with psychotherapy and antidepressant drugs, both of which require professional input.
For more information, including locations of support groups and other resources in her area, contact the National Eating Disorders Association at (206) 382-3587 or www.edap.org.
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Side effects experienced by people taking the drug included severe infections (2 percent), as well as depression or gallbladder problems (fewer than 1 percent).