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Health Talk 

Kandace Power Graves discusses eating disorders with Susan G. Willard, a social worker, professor of psychiatry and pediatrics at Tulane University School of Medicine and clinical director of the Eating Disorders Treatment Center at River Oaks Hospital. She is co-author with Deborah M. Michel, a assistant professor of psychiatry and neurology at Tulane, of the new book When Dieting Becomes Dangerous: A Guide to Understanding and Treating Anorexia and Bulimia (Yale University Press, January 31, 2003).

Q: The National Eating Disorders Organization estimates that between five and 10 million women and one million men suffer from eating disorders. Why is the rate so much higher in females?

A: The emphasis on thinness and body shape are greater for women than for men, and the media has done more damage in defining beauty in terms of weight and shape for women than it has for men. We believe that body image distortion also occurs more commonly in women than it does in men. For example, most women see themselves larger than they actually are, and women's self esteem hinges more on their physical appearance than men's self esteem does.

Q: Why is that?

A: It has a lot to do with culture. There are fewer eating disorders found in African-American women than in caucasian women. This is thought to be that being extremely thin is more desirable to caucasian men than African-American men.

Q: Are there biologic triggers to eating disorders or are they psychological in nature?

A: There is a great deal of research going on right now on the genetics of eating disorders, particularly anorexia nervosa. What has been discovered thus far is that there are certain traits that are genetically transmitted that place individuals at risk for the development of eating disorders. ... There are common traits associated with anorexia nervosa and those same traits seem to be present in family members. Some examples are perfectionism, obsessive and compulsive features and anxiety.

Q: When do eating disorders generally begin?

A: The typical age of onset for anorexia is between 14 and 19, and the typical age of onset for bulimia is 16 to 24, although those ranges by no means define the age of onset.

Q: What is the greatest danger when it comes to anorexia and bulimia?

A: Death. Anorexia nervosa has the highest mortality rate of any psychiatric disorder. The mortality rate is between 15 and 20 percent of patients. The mortality rate with bulimia is lower.

Q: How can parents detect whether a child is in danger of developing anorexia or bulimia?

A: For anorexia nervosa, parents should be concerned if their daughter has precipitous weight loss, is over-concerned with calories and fat grams and is visibly restricting food intake. ... The two most common signs that their daughter may have bulimia is large volumes of food missing and frequent trips to the bathroom after eating. If parents ... and their physician (are) concerned about an eating disorder, then treatment should be sought from a team of eating disorder specialists. It is critical to realize these are psychiatric diagnoses.

Q: Do these diseases normally come with other complications?

A: Eating disorders very often occur simultaneously with other psychiatric problems such as depression, anxiety disorders, obsessive compulsive disorders and substance abuse.

Q: What professionals are normally the best equipped to deal with eating disorders?

A: In my opinion a comprehensive team is required to adequately treat these diseases. The team would consist of an individual psychotherapist -- that could be a social worker, licensed professional counselor, psychologist or psychiatrist -- a family therapist, a nutritionist and a physician.

Q: The family needs to receive treatment also?

A: Eating disorders don't ever occur in a vacuum, and the family is the context out of which our children grow. Therefore, the family needs to be involved in the treatment process.

Q: Do you find that if there is a child with anorexia or bulimia, there is someone else in the family who suffers from it also?

A: Research has shown that there is a general family history of these kinds of problems, but that is by no means the case all the time. I think it's always a mistake to blame anyone for the occurrence of any eating disorder. The task of the therapist is to help the family put the pieces together to figure out and understand what causes and maintains the illness.

Q: Once diagnosed, is there a good success rate?

A: The success rate depends completely on the motivation of the patient and the family and the treatment that they receive. The longer these problems go undiagnosed and untreated, the more unlikely it is that the illness will be reversed.

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