You might think of anorexia and bulimia as adolescent disorders, but it's a problem plaguing adults, too. Anorexia, in which people have an intense fear of gaining weight and drastically restrict their food intake, cuts across ethnic and socioeconomic boundaries. But it strikes mostly women: About 90% of those with the condition are female, and about 20% of women still struggle with it into their 30s and beyond.
While there's no hard data on how many adult women have symptoms of anorexia, the National Eating Disorders Association (NEDA) says that body image dissatisfaction is a risk factor for clinical eating disorders. And it's on the rise in midlife women, more than doubling from 25% in 1972 to 56% in 1997, according to the most recent data available from NEDA. In fact, about 30% to 50% of teens who have anorexia don't recover by their early to mid-20s.
What causes anorexia? The latest research shows the illness has more to do with your brain than with societal influences or the way you were parented. "When people with anorexia get hungry, their brains are not getting the right signals," explains Walter H. Kaye, MD, professor of psychiatry at the University of California, San Diego School of Medicine and head of UCSD's Eating Disorders Program.
The Anorexic Brain
Specifically, new brain imaging studies indicate that people with anorexia have abnormal functioning of the serotonin and dopamine systems. Serotonin is a brain chemical that plays a role in satiety, impulse control, and mood, while dopamine causes us to be attracted to positive stimuli. Brain scans have found that people with disordered eating -- and even those who have recovered -- have difficulty discriminating between positive and negative feedback. They are put off by things that most people find pleasurable, such as good food. And being forced to eat only increases the aversion to food.
The persistence of these malfunctions could provide a clue to why the disorder can persist long past the teen years, Kaye says. It's difficult for people with anorexia to maintain healthy eating habits, for example, because hunger doesn't cause them to find food appetizing. Kaye hopes this information will lead to new treatments, such as exercises to increase flexibility in thinking. "These temperaments won't go away," he says, "but we can manage them."
Helping Those With Eating Disorders
Science suggests inherited traits contribute to eating disorders. About 8% of people with disordered eating have a first-degree relative, such as a mother or sister, with anorexia.
If you or someone you know is struggling with an eating disorder, Kaye offers these insights:
Think long term. Recovery may be a long process. Anorexia seems to be related to personality and temperament traits that are rooted in the brain, which remain even after people go into treatment.
Have a family plan. It's not just the patient -- the whole family needs to help with recovery. Family therapy can help others learn how not to trigger anorexic behavior.
Get professional help. As with any disease, people with anorexia can't combat it alone; find a treatment program that meets the needs of adults. Contact NEDA for more resources and information.