Eating disorders pose a long-term problem

Anorexia, bulimia need early treatment People with anorexia and bulimia see food as their greatest enemy. Achieving even a fragile truce, new data show, may require lengthy

Monday, April 10th 2000, 12:00 am

By: News On 6

Anorexia, bulimia need early treatment

People with anorexia and bulimia see food as their greatest enemy. Achieving even a fragile truce, new data show, may require lengthy negotiations.

Researchers are now releasing some of the first studies that examine patients many years after diagnosis. With these results, the long-term effects of eating disorders are coming into focus.

In many respects, the findings are encouraging. Several studies suggest that at least half of anorexia patients appear to be fully recovered a decade or two later.

But the remaining half are a great concern. In one of the latest studies of anorexia, which followed 84 women in Germany for 21 years, 10 percent of the patients were still fully anorexic, and almost 16 percent had died.

Overall, studies suggest that anorexia's mortality rate may be higher than that of any other psychiatric condition.

"It remains a very mysterious illness, and extremely difficult to treat," said Dr. Michael Strober, head of the eating disorders program at the University of California, Los Angeles.
The long-term research is helping scientists better refine recovery programs and identify patients most at risk for relapse. Doctors already know that anorexia and bulimia are psychiatric diseases that strike mostly teenage girls. In anorexia, girls starve themselves, and often exercise compulsively. Bulimic girls will binge on large amounts of food, and purge the meal by vomiting or taking laxatives. Often, girls with anorexia also have symptoms of bulimia.

Treatment is complicated, because the disorders aren't just about a relentless pursuit of thinness. They are also rooted in matters of self-esteem, control and stress. Most therapies have been adapted from the treatment of other psychiatric conditions, experts say, but the complexity of eating disorders demands more precise therapy.

While anorexia and bulimia have much in common with other mental illnesses, they are also very different, said Dr. Walter Kaye, head of eating disorders research at the University of Pittsburgh. Unlike other psychiatric conditions, which tend to appear across populations, these disorders overwhelmingly strike girls around the age of puberty and in the late teens. The victims are often perfectionists and high achievers, almost to the point of obsession.

"All these things, you don't see in other illnesses," Dr. Kaye said. Yet like other mental illnesses, he said, "these disorders are biologically based and need treatment."

New guidelines for treating eating disorders were published in January in The American Journal of Psychiatry. These emphasize the need for treating patients as early as possible, as intensively as necessary, for as long as needed. Sometimes, the symptoms of anorexia won't completely disappear until years after treatment has begun.

"It takes a long time," said UCLA'S Dr. Strober, whose research has found that recovery from anorexia can take from 57 to 79 months.

Dr. Strober has reported that nearly three-fourths of the patients he has followed remain fully recovered 10 to 15 years after they first checked into the hospital, and that relapse in this group is uncommon. This success rate is higher than in some other studies, a finding he attributes to the aggressive treatment the women in his program receive after diagnosis.

"People who are very ill probably need months of hospitalization, and they rarely get it," he said.

Researchers know less about the long-term outlook for people with bulimia. This is partly because the condition wasn't identified until 1979, so there has been less time to follow patients, said Dr. Scott Crow of the University of Minnesota.

Last year, Dr. Crow reported that among a group of about 200 women with bulimia, 70 percent were in full or partial remission more than 10 years after they entered the hospital. Bulimia also doesn't appear to carry the high death rate associated with anorexia. Still, like other physicians, Dr. Crow is troubled by the number of women with eating disorders who go for years without getting better.

"We need badly to come up with more effective treatments," he said.

Long-term studies could also help identify patients who will have the most difficult time recovering, and who may need greater help overcoming a fear of eating and gaining weight. For example, in the 21-year German study, published in February in the journal The Lancet, women were less likely to recover the longer they had suffered from the disorder without treatment.

Other studies have also suggested that the longer the illness lasts - or the less a person weighs before checking into a hospital - the more difficult the recovery. These studies can't tell why treatment gets delayed, said Dr. David Herzog, director of the eating disorders unit at Massachusetts General Hospital. The condition could have gone unrecognized, or the person could have just been unwilling to seek help.
Whatever the reason, the importance of early treatment underscores the need for better awareness of eating disorders, he said.

Families, teachers, coaches and others who commonly interact with teenage girls need to watch for warning signs, he said, especially a profound, unexplained weight loss. Patients need to get into treatment as soon as possible.

Anorexia is "not a benign illness," Dr. Herzog said. "People die."

Although the long-term data show that early treatment is crucial, it can be difficult for parents to find, doctors say. One mother from Rockwall, whose daughter developed anorexia three years ago at age 15, found that the insurance company initially said it would pay for her daughter to go only to a drug rehab hospital.

Her daughter eventually ended up in the emergency room at Children's Medical Center, weighing 70 pounds and experiencing dangerous drops in blood pressure.

"I had to sign papers saying I was totally responsible for all the bills," said the mother, whose daughter wishes to remain anonymous. While the insurance company did eventually pay for the six-week hospital stay at Children's, she said, "it would have been so much cheaper for them to have her not end up in the emergency room."

From her own experience, the mother agrees with long-term studies that show early treatment is vital. Her daughter, who was admitted to the hospital three months after she began starving herself, has now gained 30 pounds, and continues on a delicate course to good health. Parents should watch their children closely, the mother says, and fight for the treatment they need.

"I know that a lot of these parents are in total denial," she said. "Do you want to get help for your daughters, or do you let them wither away?"

For more information:
The National Association of Anorexia Nervosa and Associated Disorders at www.anad.org is a nonprofit group that assists victims and their families.

The American Anorexia Bulimia Association has a Web site at www.aabainc.org

The American Psychiatric Association also has information about eating disorders on its Web site at www.psych.org.

A new book, Stick Figure, by Lori Gottlieb, is a publication of the author's adolescent diaries and offers a glimpse into the mind of a anorexic young girl obsessed with thinness.
(Simon & Schuster, $22, hardcover, 220 pages)

Anatomy of Anorexia by Steven Levenkron discusses new treatments and offers advice to families to help their children. (W.W. Norton & Co., 288 pages, $24.95 hardcover)