Eating Disorders: Counseling Issues

Bulimia and anorexia are binge-eating and starving disorders afflicting thousands of adolescent and young adult women each year.

Characteristics of Bulimia and Anorexia

Diagnostic criteria established by the American Psychiatric Association include the following:

Bulimia

The majority of bulimics binge in secret and resort to self-induced vomiting or purging. A typical binge averages 4,000 calories, lasts an hour, and occurs twice a day. Diagnostic criteria include recurrent episodes of binge-eating; awareness that the eating pattern is abnormal and fear of being unable to stop voluntarily; and depressed mood and self-deprecating thoughts after binging.

Anorexia

Anorexics may also binge/purge and abuse physical exercise. Usually, they suffer from more severe psychological and medical problems than bulimics.

Diagnostic criteria include a 25% weight loss or a body weight 25% below normal; an intense fear of becoming obese that does not diminish with weight loss; a distorted body image (feeling fat or "just right" even when emaciated); and a refusal to maintain weight above a minimum norm for age and height.

Extent of Bulimia and Anorexia

Estimates of the extent of eating disorders range from 500,000 for bulimia and anorexia combined to 5 million for bulimia alone. Estimates of incidence also vary, from 3.8% to 13% for bulimia and .6% to 11% for anorexia. The lack of consensus on data derives from variables inherent in victims' self-reports, an inconsistency among operational definitions of the disorders, and the differences between clinical and non-clinical populations.

Psychosocial Profile

The typical image of the eating disordered is the "model child" or "perfect little Princess"; behind this image lies a poor sense of self, intense need for approval; and compulsive high-achievement. Because flaws are seen as failures which can invite rejection, a pervasive anxiety dominates their lives. To cope socially, bulimics tend to be gregarious impression-managers, while anorexics may simply withdraw.

The wider context for these disorders, according to some theorists, is women's social dependency in a culture that idealizes thin female bodies. In this view, dependency defines females in terms of "other" rather than "self," making them highly responsive to external demands and rewards, less likely to develop internal resources, and especially vulnerable to perceived failure and rejection.

Family Profile

Some research shows that bulimics and anorexics typically come from families who depend excessively on each other and cannnot handle stess and anger. "Enmeshed" is an apt description: what they consume, wear and do and how well they appear, behave, and perform are all regarded as everybody's business and extremely important.

Paradoxically, the eating disorder functions to preserve family stability. The victim secures some sense of identity, approval, and control through the special attention her illness requires; other members acquire a unifying focus for their own roles. The net effect is to reinforce the family's mutual dependencies and to hide underlying conflicts.