Anorexia nervosa and bulimia
This condition usually afflicts bright, able, intelligent, often well-educated obsessional women of around 16–25 years of age who see themselves as too fat. Men may suffer this disorder but the women far outnumber them. At the beginning they may indeed be slightly plumper than average but they are rarely overweight. In an effort to become what they believe is a desirable weight they begin to eat less and this at first causes little alarm among their families and friends because being thin is generally fashionable for young women. In contrast to the people who are actually overweight, for whom losing weight is really necessary and who usually talk and complain a good deal about their troubles, anorexics mostly say nothing about their dieting and may even go to some effort to conceal the fact that they are eating less. They therefore often eat mainly or only in private. Later, when they have lost enough weight to worry their families they maintain that they are still too fat and may even pinch up a piece of wasted flesh to demonstrate how fat they are, although they are obviously alarmingly thin. It is a remarkable disorder of perception and rational discussion is almost always fruitless. By this time, when they weigh perhaps only 35–40 kg (80–90 lb), there is likely to be some anaemia and in women menstruation will have ceased. Such people are usually irritable and emotionally isolated, having given up most or all of their social life and perhaps even their job. They may now see themselves as of a desirable size or may even yet believe that they are still too fat, continuing to lose weight until they are in grave danger of dying. Family tensions at this stage are usually running high and psychotherapy will probably be needed for everyone with whom the anorexics are living. It is amazing how far advanced the anorexic condition becomes before medical help is sought.
Treatment consists of specialist re-feeding, often in hospital, and psychotherapy. Only about half recover fully. Of the others, about 5 per cent die of starvation and the rest live out their lives only partially back to normal. The cause of anorexia nervosa is unknown.
In this variation of abnormal perception of body image, the subject, once again usually a young woman, tries to control body weight by inducing vomiting. This is sometimes preceded by binge eating. The periods of binge eating and vomiting are often followed by periods of reduced food intake which in some cases may be indistinguishable from anorexia nervosa. Body weight loss in bulimia is less likely to be as drastic as that in anorexia nervosa and therefore less life-threatening. The cause of bulimia is unknown.