***Secret Sufferings in Plain Sight

Amy Winehouse’s brother, Alex, reported to the Observer Magazine ( http://www.guardian.co.uk/music/2013/jun/23/amy-winehouse-growing-up-sister ) that he believes Bulimia killed his sister.

Although the family knew Amy suffered from an eating disorder since her early teens, Alex says no one talked about it. The Winehouse family is indicative of so many other families who have a loved one who is suffering with an eating disorder . The family thinks, “it’s not that bad” or “she will grow out of it.” Sometimes the signs are there, but you just don’t want to believe it.

Michael Jackson also suffered from the classic symptoms of an eating disorder. Like Amy he was reported to die from an overdose. Although the physical signs of his deteriorating health were so obvious, it was never mentioned that his eating disorder was killing him. His strenuous dance routines made him famous but it also may have contributed to his death . Many people with bulimia nervosa use strenuous exercise as a way of purging calories. Like most people with eating disorders , Michael Jackson obviously had problems regarding his body image and perfectionism. He had numerous plastic surgeries, and was constantly trying new diets and body cleansing routines. All this had become his eating disorder obsession to change the man in the mirror.

There are so many deaths that are really caused by an eating disorder but attributed to other causes. People with anorexia nervosa are reported to die of organ failure and we hear of extreme athletes in perfect condition suddenly die of a heart attack.  The general public does not know that heart attacks can occur from electrolyte and potassium imbalances brought on by eating disorders . Anorexia has the highest mortality rate of any mental illness.

So how is it that all these celebrities can suffer in silence and no one do anything about it? Over the years, as a therapist, I have seen so many people report having alcohol and drug problems but they will deny having an eating disorder. Eating disorders are where alcoholism treatment was 20 years ago.  Eating disorders are still not talked about or understood. It is killing people in plain sight.  The sufferer or the people around them do not recognize or acknowledge eating disorders .

One thing that even therapists miss is that some patients who develop alcohol and drug problems are doing so to cope with their underlying eating disorder. It is common to find that patients who enter eating disorder treatment discover that as an adolescent they struggled with weight, body image and dieting.  Eating disorders are often used to deal with stress and emotions.  When someone with an eating disorder tries alcohol or drugs they may find a temporary relief from the eating disorder obsession. The stress-relieving benefits of the eating disorder are replaced by the use of alcohol or drugs.

Currently there are no statistics about the prevalence of eating disorders present before progressing to addictions; but it is a common phenomenon that when people with addictions stop using alcohol and drugs they often turn to food and eating disordered behaviors.  Some recovering people will struggle with obesity for the rest of their life.  Others will be ashamed of their secret disordered eating behaviors and relapse. Others may decide to use appetite suppressants or other medication that lead them back to their addictions. We see many eating disorder patients using stimulates like Cocaine and Methamphetamine as a way to remain thin.

Here are some signs and symptoms of eating disorders:

Anorexia is usually detected by a significant loss of weight and an intense fear of gaining weight, even though underweight. It is important to realize that due to chemical disturbances in the brain they really do see themself as fat. They may be hospitalized due to dehydration, gastrointestinal complaints, stress or exercise injuries, depression, anxiety , headaches or dizziness but the eating disorder often goes undetected.

At the dinner table someone with anorexia may say, “I am not hungry” or “I have already eaten.” They will avoid whole groups of food, eating only salads, raw vegetables, fat-free, or low carb foods. They may excessively chew every bite and shift food around on the plate to look like they have eaten. They want to cook their own food to make sure nothing fattening was added. They will eat the same few foods at all meals. Some other noticeable signs are:

• Usually cold and dress in layers to hide their diminished size
• Appears high due to chemical disturbances and malnutrition
• May lose their monthly menses and have infertility problems
• May develop fine body hair on face, stomach, arms, legs
• Skin, hair and nails become brittle, dry, and thin
• Must exercise
• Exhibit angry outbursts, bouts of crying and moodiness

Bulimia is characterized by eating more large amounts of food, but not gaining weight. They may hide food to eat alone. They may want a snack even after a large meal. They will frequently go to the bathroom during or following meals to purge the food. They will be defensive when asked about eating or exercise . The family may notice significant weight fluctuations. They may have callouses on their knuckles if they are using their finger to vomit. They will exit the bathroom with bloodshot eyes and act like nothing is wrong or they may say they are sick. Other signs and symptoms include:

• Tooth enamel eroded on front teeth
• Tends to have swollen glands at jaw and cheeks
• Must exercise
• Take excessive laxatives or diuretics
• Chronic sore throat, stomach and intestinal problems

Binge eating and compulsive overeating is used to deal with life stresses or emotions. They may have periods of time where they eat a lot of food in a short period of time and then restrict food intake later. They will go on one diet after another and “relapsing” between diets. They can be of any physical size. Other symptoms are:

• Constantly thinking about food
• Feeling that they cannot stop eating if they start
• Eating alone because of being embarrassed by how much they are eating at one time
• Feeling disgusted with themselves, depressed, or very guilty after overeating

Food Addictions are the most overlooked contributing factor to an eating disorder. Not all people who have an eating disorder have a food addiction . The most common foods that can be addictive are sugar, fat, flour, refined processed foods, and fast foods. People who are unaware of the effects these foods have on them will have difficulty recovering from an eating disorder.

• Have periods when they must have a certain food
• May steal or violate their values to obtain food
• Once they have a bite there must be more
• Lies about the food to themselves and others
• Feels numbed, drugged, or high after eating their binge food
• Experiences detoxification when eliminating the binge food

Eating disorder can be deadly. They can lead to other addictions, depression, health problems, suicide, obesity , and death .  Someone with an eating disorder needs professional help from a licensed professional who is an eating disorder specialist. It may be important to find an eating disorder treatment program to interrupt the eating disorder cycle and build a foundation for lasting recovery.