Each year millions of people develop serious and sometimes life-threatening eating disorders. The vast majority- more than 90 percent – of those afflicted with eating disorders are adolescent and young adult women. One reason that women in this age group are particularly vulnerable to eating disorders is their tendency to go on strict diets to achieve an “ideal” figure. Researchers have found that such stringent dieting can play a key role in triggering eating disorders.

Approximately 1 percent of adolescent girls develop anorexia nervosa, a dangerous condition in which they can literally starve themselves to death. Another 2 or 3 percent of young women develop bulimia nervosa, a destructive pattern of excessive overeating followed by vomiting or other “purging” behaviors to control their weight. These eating disorders also occur in men and older women, but much less frequently.

The consequences of eating disorders can be severe, with 1 in 10 leading to death from starvation, cardiac arrest, or suicide. Fortunately, increasing awareness of the dangers of eating disorders – sparked by medical studies and extensive media coverage of the illness – has led many people to seek help. Nevertheless, some people with eating disorders refuse to admit that they have a problem and do not get treatment. Family members and friends can help recognize the problem and encourage the person to seek treatment.

Anorexia Nervosa, which usually begins in young people around the time of puberty, involves extreme weight loss – at least 15 percent below the individual’s normal body weight. Many people with the disorder look emaciated but are convinced they are overweight. Sometimes they must be hospitalized to prevent starvation. Food and weight become obsessions. For some, the compulsiveness shows up in strange eating rituals or the refusal to eat in front of others. It is not uncommon for people with anorexia to collect recipes and prepare gourmet feasts for family and friends, but not partake in the meals themselves. They may adhere to strict exercise routines to keep off weight. Loss of monthly menstrual periods is typical in women with the disorder. Men with anorexia often become impotent.

People with bulimia nervosa consume large amounts of food and then rid their bodies of the excess calories by vomiting, abusing laxatives or diuretics, taking enemas, or exercising obsessively. Some use a combination of all these forms of purging. Because many individuals with bulimia “binge and purge” in secret and maintain normal or above average normal body weight, they can often successfully hide their problem from others for years.

Family, friends and physicians may have difficulty detecting bulimia in someone they know. Many individuals with the disorder remain at normal body weight or above because of their frequent binges and purges, which can range from once or twice a week to several times a day. Dieting heavily between episodes of binging and purging is also common. Eventually, half of those with anorexia will develop bulimia.

As with anorexia, bulimia typically begins during adolescence. The condition occurs most often in women but is also found in men. Many individuals with bulimia, ashamed of their strange habits, do not seek help until they reach their thirties or forties. By this time, their eating behavior is deeply ingrained and more difficult to change.

In patients with anorexia, starvation can damage vital organs such as the heart and brain. To protect itself, the body shifts into “slow gear”: monthly menstrual periods stop, breathing, pulse, and blood pressure rates drop, and thyroid function slows. Nails and hair become brittle; the skin dries, yellows, and becomes covered with soft hair called lanugo. Excessive thirst contributes to constipation, and reduced body fat leads to lowered body temperature and the inability to withstand cold.

Mild anemia, swollen joints, reduced muscle mass, and light-headedness also commonly occur in anorexia. If the disorder becomes severe, patients may lose calcium from their bones, making them brittle and prone to breakage. They may also experience irregular heart rhythms and heart failure. In some patients, the brain shrinks, causing personality changes. Fortunately, this condition can be reversed when normal weight is reestablished.

Most people with eating disorders share certain personality traits: low self-esteem, feelings of helplessness, and a fear of becoming fat. In anorexia and bulimia, eating behaviors seem to develop as a way of handling stress and anxieties. People with anorexia tend to rarely disobey, keep their feelings to themselves, and tend to be perfectionists, good students, and excellent athletes. Some researchers believe that people with anorexia restrict food – particularly carbohydrates – to gain a sense of control in some area of their lives. Having followed the wishes of others for the most part, they have not learned how to cope with the problems typical of adolescence, growing up, and becoming independent. Controlling their weight appears to offer two advantages, at least initially: they can take control of their bodies, and gain approval from others. However, it eventually becomes clear to others that they are out-of-control and dangerously thin.

Eating disorders are most successfully treated when diagnosed early. Unfortunately, even when family members confront the ill person about his or her behavior or physicians make a diagnosis, individuals with eating disorders may deny that they have a problem. Thus, people with eating disorders may not receive medical or psychological attention until they have already become dangerously thin and malnourished.

However, it cannot be overemphasized how important treatment is – the sooner the better.