Anorexia nervosa and other eating disorders pose new diagnostic and treatment challenges as they affect younger and older patients.
Kathleen Phalen Tomaselli
It was a daily menu of gum and tea sprinkled with 20 or so over-the-counter diet and water pills, 10 laxatives and six hours running on the treadmill. A few times a week, she would cut on her body with knives she kept taped under chairs; a release of pain, anger and starved emotions. At night she would lie awake, agonizing about how she could stay committed to this regimen.
"I'd eat one meal a week if I had to," says Sherri Crowl, now 40, of Edinboro, Pa. "My eating disorder started when I was 8." After 30 years, Crowl was diagnosed with anorexia nervosa. "I kept thinking, if I could be thinner, people would be in awe of me and want to be that size, too."
...Bodies of all ages fade into wisps of what once was, and anorexics are dying at a rate of 10 percent to 20 percent from complications of starvation or from suicide. Still, skeletal frames continue to sashay down runways; extreme-makeover programs highlight body perfection; and reality shows reward weight loss and excessive exercise. In the war on obesity, thinness has become the hallmark of success. "There's this continued glorifying of unhealthy and unnatural images," says Harry A. Brandt, MD, a psychiatrist and medical director of the Center for Eating Disorders at the Sheppard Pratt Health System in Baltimore.
To further complicate diagnosis, anorexia is no longer only a disorder of white teenage girls. It affects all ages, races and cultures. It even can cross gender boundaries. About 15 percent of anorexics are men. "Men are underdiagnosed and undertreated," Dr. Brandt says. "If a man loses weight, the physician does a mega medical work-up. It couldn't possibly be an eating disorder."
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