Anorexia and Bulemia

Q:  The late singer Karen Carpenter died at age 32 reportedly of a heart attack related to her problem with anorexia and possibly bulemia. Since this matter was fatal to a woman who was young, beautiful, talented, rich and well educated, I suspect that it might be reckless to say that my family or other families are guaranteed to be safe from this problem. Perhaps you can tell us something about these disorders.

A:  Anorexia nervosa (AN) is mostly a finding in adolescent, well-educated, middle to upper class women. They suffer from a grossly distorted self-image convinced that they are seriously overweight regardless of a physique often reminiscent of a victim of starvation, which is in fact the case. Sadly, as many as one in in ten women with AN began showing symptoms as early as the fourth grade. A profound calorie deficit in combination with poor nutrition sets the stage for chemical imbalances, especially potassium, that can cause fatal heart rhythms as well as protein deficiencies that can also be dangerous to the heart.

These young women often feel that they have been raised in households with controlling and critical parents who are demanding and strive for perfection. Exterior looks are too highly prized and are the object of regular commentary, often at the time of life when young women are in the greatest need of encouragement and support. It is no help today that, more than ever, the fashion industry continues to emphasize the maintenance of an unreasonably thin physique. There are also fears around emerging sexuality that may play a role, and that parents should at least ask about.

Bulemics engage in binge eating of voluminous amounts of food followed by guilt and self-induced vomiting. Bulemics are at risk for tooth decay due to the acidity of stomach contents as they pass repeatedly through the mouth as well as rips in the esophagus that may result in potentially life threatening bleeding. They are also at risk for some of the same chemical disturbances described with AN.

The best way to prevent either or both of these conditions from occurring is to love and support your daughters. Adolescent women are acutely sensitive and will internalize any negative criticism about the way they look and comments about what they eat. A series of offhand comments about excessive weight gain or dietary indiscretions in the context of a generally perfectionist and emotionally cold home environment can be terribly detrimental and destructive. Truthfully praise and physically embrace your daughters. Discover the things they do well and become their biggest fans. Don't overlook their faults completely, but don't constantly hold them under a magnifying glass.

Adolescence is a great opportunity for parents to build the kind of relationship they want to have with their children, one that can wonderfully extend into adulthood and to set the stage for long term emotional and physical health. Seize the day!

Dr. Russell Robertson is Associate Dean for Faculty Affairs and Associate Professor of Family and Community Medicine at the Medical College of Wisconsin. His biweekly column of medical advice also appears in the CNI Community Newspapers throughout metropolitan Milwaukee.