WASTING AWAY: ANOREXIA AND BULIMIA Why does food become a deadly enemy for some people? This week, we look at anorexia and bulimia. Guests include Dr. Kelly Brownell, Director of the Yale University Center for Eating and Weight Disorders; Dr. Joan Jacobs Brumberg, a historian at Cornell University and author of Fasting Girls: The History of Anorexia Nervosa and The Body Project: An Intimate History of American Girls; Dr. Walter Kaye, director of the eating disorders clinic at the University of Pittsburgh School of Medicine and an expert on genetics; and Marya Hornbacher, author of Wasted: A Memoir of Anorexia and Bulimia.
Host Dr. Fred Goodwin begins the show with an essay about how the drive for food, like the drive for sex, is necessary for survival. Because the need for food is such a basic drive, it makes sense that eating disorders involve parts of the brain intertwined with the regulation of emotion-related behaviors. Thus, they often overlap with other disorders of mood and behavior regulation, including clinical depression, anxiety disorders, obsessive compulsive disorder, body image distortions, impulse control problems, and substance abuse. As most people correctly assume, culture also plays an important role in the development and expression of eating disorders: an abundance of food, media images of stick-thin supermodels and a general preoccupation with weight in Western society. It is this dance between biology and culture that we will explore on the show. Next, we hear first-person accounts of eating disorders from two women who ultimately sought treatment through The Renfrew Center, a women's mental health center with locations around the country. The first, Wendy, describes her experience with anorexia. She first started restricting her eating when she was thirteen years old. As she became thinner, she received positive reinforcement from people around her, and she began to restrict more and more. She's 5'2" tall, and at her lowest weight, she was 78 pounds. Wendy admits she has serious issues with control, in part because she was sexually abused as a young child, which left her feeling helpless and out of control. Eating was one area of her life where she could exert total control. Although hospitalized several times against her will, she continued to find ways to manipulate her doctors and lose even more weight. Ultimately, in her early twenties, she realized she would never be able to lead the kind of life she wanted, with marriage and a family, if she continued to suffer from an eating disorder. She is now in the process of recovery.Next Janine recounts her experience with anorexia and bulimia. Her bulimia involved not only bingeing and purging but also what's called "exercise bulimia" -- excessive, obsessional exercising. In high school, Janine would wake up every day at 5:00 AM to go running before school. She became obsessed with food and weight. In college, with no one watching her, things got even worse. She ran at least two or three times every day, and when she ate something, she would think about it for the next five or six hours. If she missed her 5:00 AM run, she would go into the bathroom and heat up a curling iron and attempt to burn the fat off her thighs. She says she now realizes this was all in an attempt to be "good enough," or, really, perfect. She considers herself recovered now, and can't believe the sick extremes she once went to in her attempts to control her body.For more information about The Renfrew Center, please go to http://www.renfrew.org or call 1-800-736-3739. Compulsive overeating, or binge-eating disorder is marked by bingeing without purging. People with this disorder tend to be overweight, and are often older at onset than anorexics and bulimics. Dr. Brownell adds that there is an evolutionary theory that might explain eating disorders. When scarcity was the norm, natural selection would have rewarded those who ate as much as possible when food was available (after a successful hunt, for example). Now that we live in a time of food abundance, those same genes would cause someone to overeat, making them feel out of line with societal views of beauty. In people with other vulnerability factors, this might lead to severe restricting behavior. Dr. Goodwin then asks Dr. Brumberg about the cultural context in which eating disorders developed. Contrary to popular belief, these disorders are not just a product of modern media. They were first recognized and named in the 1870s, simultaneously in Britain, France, and the US. She says they are multi-determined diseases -- part biology, part individual psychology (temperament, family psychology, etc.), and part culture.In the 1870s, body image began to be associated with social class. The upper classes wanted to distance themselves from robust farm wives and other working class women. Despite an abundance of food available to the well-to-do, being thin became one way to show your status in society. For some women, this was one factor leading to extremes in eating behavior. Dr. Goodwin next asks Dr. Brownell about the biological aspects of the disease. He answers that it's hard to know what is inherited -- it could be a certain type of metabolism that would require some people to restrict more than others to lose weight, or it could be personality traits. People with eating disorders tend to be very controlling, perfectionistic, and anxious. He adds that there are warning signs for parents to look out for - changes in behavior, severe weight loss (in the case of anorexia), sneaking away after meals to purge (in the case of bulimia), and excessive or obsessional thoughts about food, diet, and exercise. Dr. Brownell also says that there are effective treatments for these disorders. For severe anorexia, the first step is often hospitalization, since the person may be in medical crisis. Then a combination of individual, family, and group psychotherapy is recommended. For bulimia, Dr. Brownell recommends either cognitive-behavior therapy, which deals mainly with the symptoms of the disorder and works to restore regular eating patterns, or interpersonal psychotherapy, which focuses not on the symptoms but on the important relationships in the person's life.For binge-eating disorder, Dr. Brownell recommends combining one of the types of therapies used for bulimia (either cognitive-behavioral or interpersonal) with a standard weight loss program. To contact Dr. Brownell, write to: Dr. Kelly Brownell; Director, Yale Center for Eating and Weight Disorders; Yale University Department of Psychology; 405 Temple Street; P.O. Box 208205; New Haven, CT 06520-8205. Or visit: http://www.yale.edu/ycewd. To contact Dr. Brumberg, write to: Dr. Joan Jacobs Brumberg; College of Human Ecology; G60b Martha Van Rensselaer Hall; Cornell University; Ithaca, NY 14853-4401. Or visit: http://www.human.cornell.edu. Next, Dr. Goodwin is joined by writer Marya Hornbacher. Ms. Hornbacher begins by reading from her book WASTED: A Memoir of Anorexia and Bulimia. She dropped to 52 pounds and was given one week to live. Although she had been hospitalized many times before, she finally decided she wanted to get well, and she began to recover. Like an alcoholic, she says, someone with an eating disorder will only begin responding to treatment when she is ready. To contact Ms. Hornbacher, please write to: Ms. Marya Hornbacher; c/o The Frances Goldin Literary Agency; 57 East 11th street, Suite 5B; New York, NY 10003. Dr. Goodwin's final guest is Dr. Walter Kaye, director of the eating disorders clinic at the University of Pittsburgh School of Medicine and an expert on genetics. Dr. Kaye believes that the study of eating disorders is now at a point where the study of schizophrenia and autism were twenty to thirty years ago -- people are just coming to accept that there may be biological, as well as a psychosocial, causes. New longitudinal studies looking at twins show that eating disorders are highly heritable. Dr. Kaye believes the primary contribution to these disorders is genetic. Dr Kaye has also studied the brain chemistry of people who have recovered from anorexia and bulimia and found changes in the serotonin receptors in their brains. One theory is that people who are particularly anxious, as those with eating disorders tend to be, may attempt to modulate their brain chemistry with food. To contact Dr. Kaye, write to: Dr. Walter Kaye; Department of Psychiatry; Thomas Detre Hall of the Western Psychiatric Institute and Clinic; University of Pittsburgh; 3811 O'Hara Street; Pittsburgh, PA 15213. Or visit: http://www.wpic.pitt.edu. Finally, commentator John Hockenberry offers his thoughts on Hollywood's approach to body image. To learn more about eating disorders, please visit The National Eating Disorders Association at http://www.edap.org. Heard on this week's The Infinite Mind: |