SPECIFIC QUESTIONS AND ANSWERS on Eating Disorders

alt.support.eating-disord newsgroup

Yes, certainly a.s.e-d addresses compulsive overeaters, and all people with an eating disorder. See more on this in FAQ 1, DIAGNOSIS & TREATMENT. As of April 1995 there is also a group specifically for compulsive overeaters: alt.recovery.compulsive-eat.

My understanding is that a diagnosis of compulsive overeating differs from a diagnosis of bulimia mainly in that the compensatory behavior of bulimia (fasting, vomiting, laxative abuse, diuretics, overexercising) is absent, so the compulsive overeater gains weight. Since bulimia is so firmly identified in the public mind with self-induced vomiting only, those who use other compensatory behaviors are very often not identified as bulimics by themselves or others.

Many people who call themselves a "compulsive overeater" probably fall within the definition of bulimia. "The Campus Health Guide" (See FAQ 2, BOOKS) has the best summary on diagnosing, treating and preventing eating disorders that I know of. In discussing bulimia, the Guide says:

"Bulimia is .. known as the binge-purge syndrome because it is characterized by frequent binge eating, resulting in physical and emotional discomfort that is relieved by purging. Bulimia criteria are: 1. Recurrent episodes of binge eating. 2. Feeling of lack of control during binges. 3. Regular episodes of self-induced vomiting, and/or use of diuretics or laxatives, and/or strict dieting or fasting, and/or vigorous exercise. 4. Minimum of two binges per week for at least 3 months. 5. Persistent overconcern with body shape and weight.

"Binges are often precipitated by dieting or fasting and are followed by self-induced vomiting or the use of purgatives (laxatives or diuretics). They are usually terminated by sleep and exhaustion, and the whole cycle is accompanied by intense feelings of shame and guilt .. Most sufferers are of normal weight. .. Bulimia may be mixed with periods of anorexia and may persist for 10 to 20 years. With professional help, bulimia can be controlled and cured."

I feel compelled to add that many bulimics testify that they have a positive pleasure, a desired "rush" in the purging, or a desired peacefulness. People will say they "eat to purge." I do not think I have ever seen this acknowledged in a book for the general public; perhaps it is in the medical literature. It is important in understanding the theory that bulimia is at least in part an addiction .. addiction to the brain chemicals produced by the vomiting as well as addiction to the chemicals produced during the binge.

For that matter, there is a whole class of books on eating disorders that never mention self-induced vomiting. Both of these omissions are vunderstandable .. mentioning the "rush" might induce people to try purging who otherwise would not do so; and describing self-induced vomiting as a weight-loss measure is apparently thought to introduce people to the idea. I have read that when some colleges embarked on an education campaign to counter bulimia, bulimia (with self-induced vomiting) increased rather than decreased. But internet newsgroups are for uncensored information .. so I include these facts here.

COMPULSIVE OVEREATING SELF-TEST

1. Do you eat when you're not hungry? 2. Do you go on eating binges for no apparent reason? 3. Do you have feelings of guilt and remorse after overeating? 4. Do you give too much time and thought to food? 5. Do you look forward with pleasure and anticipation to the time when you can eat alone? 6. Do you plan these secret binges ahead of time? 7. Do you eat sensibly before others and make up for it alone? 8. Is your weight affecting the way you live your life? 9. Have you tried to diet for a week (or longer), only to fall short of your goal? 10. Do you resent others telling you to "use a little willpower" to stop overeating? 11. Despite evidence to the contrary, have you continued to assert that you can diet "on your own" whenever you wish? 12. Do you crave to eat at a definite time, day or night, other than mealtime? 13. Do you eat to escape from worries or trouble? 14. Have you ever been treated for obesity or a food-related condition? 15. Does your eating behavior make you or others unhappy? (c) 1986, 1989 Overeaters Anonymous, Inc."

2. HOW TO HELP A FRIEND WITH E.D.: I think a staff member has bulimia, judging from things she does and from things she says. Maybe this is her way of asking for help. What can I and others do?

Dr. Paul Hamburg replied: "It sounds like this person is dropping hints regarding possible bulimic behavior. Responding to these hints is hard, because there is shame and secrecy involved in addition to the desire to be known and helped.

"I would not confront her. What you could do is ask her if she has been trying to let people know about an eating problem. Would she like to talk about it? Would she like assistance in finding help? You might obtain the telephone number of a local eating disorders evaluation/treatment center, and be prepared to offer this to her if she wants. Confidentiality, discretion and respect for privacy are essential. It is appropriate to show concern, but not to seize control."

3. DOES PROZAC (OR OTHER DRUGS) HELP EATING DISORDERS?

Do Prozac (fluoxitine) or other antidepressants or drugs provide a magic bullet for bulimia and anorexia? No. If there's a drug that can go into the body and turn off eating disorders, it hasn't been found yet. But there is some good news about a helpful role for antidepressants, in bulimia in particular.

3a. BINGE-EATING DISORDER (BED) AND COMPULSIVE OVEREATING: See BULIMIA. *

3b. BULIMIA: Use of antidepressants alone, without structured psychotherapy, is less effective than psychotherapy alone or therapy with antidepressants. A 6-month trial of cognitive therapy or interpersonal therapy, either individual or group, has the best track record for effective treatment of bulimia. These types of therapy are described below. Such "structured psychotherapy" also has much longer-lasting results than antidepressants used alone (rather than in the context of psychotherapy).

Antidepressants may play an important helping role in bulimia when several months of therapy alone has not been effective. Antidepressants are particularly useful for patients who have prominent depressive symptoms, but by no means only for them. Antidepressants are effective in bulimic patients who have no depressive symptoms, as well. Antidepressants help some patients become receptive to psychotherapy, where they were not before.

Antidepressants used alone (without structured psychotherapy) can have a significant beneficial short term effect (a period as short as 4 - 8 weeks has been reported) but relapse is likely to occur when the antidepressant is withdrawn. There has been some personal testimony in alt.support.eating-disord that antidepressant use helped them get over the hump of breaking away from binge-purge compulsions.

Note that while Prozac has gotten massive press, there are many other antidepressants that are equally effective, have a longer track record, and are much cheaper. Don't pressure your doctor to give you Prozac. Prozac's main benefit is that it tends to have fewer side effects. If side effects on longer-established antidepressants are too unpleasant, you can always considering then going to Prozac.

Doses of Prozac that are effective in bulimia are higher than the typical dose used in beginning treating depression: 60 mg for bulimia vs. 20 mg for depression. A doctor should not stop at a single trial of a single antidepressant. Successively higher doses can be tried, with careful monitoring. Often one antidepressant works where another did not. Combinations of drugs can work where a single one did not.

3c. ANOREXIA: The 1992 research paper I summarize in FAQ 1 says, "The weight of the evidence to date suggests that tricyclic antidepressants do not have an important role in the acute treatment of patients with anorexia nervosa. There is a very tentative conclusion that, "Antidepressant medications may prove to be useful in preventing relapse in patients who have achieved their target weights, but the evidence is still quite limited." Note that an a.s.e-d poster says Ativan was helpful in the early stages of hospitalized refeeding.

4. VOMITING, INDUCED:

?? What's wrong with inducing vomiting? Sounds like the perfect way to have your cake and eat it too.

There are very good reasons not to induce vomiting after a binge: it's addictive, it causes you to binge _more_, and it it hurts your body .. indeed, can be life-threatening. Repeated purge-vomiting leaves physical signs, so that knowledgeable people will know at a glance that you purge: mottled teeth, sores/scars on hands, chipmunk cheeks, etc.

Physically addictive: The "purging" very quickly becomes physically addictive. People get to the point of bingeing _so that_ they can have the "high" of purge-vomiting.

Psychologically, it sets you up for the next binge, since a little bookkeeper in your head figures you have "paid" for the binge, or canceled it, by purging. At some level you therefore feel you have permission to binge again.

Physically injurious: Preventing the binge-purge cycle could save your life. Two severe physical effects of vomiting are (1) Heart attack due to electrolyte imbalance caused by decreased potassium and other minerals.(2) Internal acid burns caused when strong stomach acid is brought up and into contact with throat and other membranes not designed to withstand them. This can lead to cancer of the esophagus, among other ills. "Minor" problems are dental problems (from stomach acid acting on teeth), weakness, dizziness, seizures, headaches, anxiety, and inability to keep warm. (kg/bjm)

5. Q: Is syrup of ipecac dangerous?