HEALTH

Eating Disorders

For reasons that are unclear, some people--mainly young women--develop potentially life-threatening eating disorders called bulimia nervosa and anorexia nervosa. People with bulimia, known as bulimics, indulge in bingeing (episodes of eating large amounts of food) and purging (getting rid of the food by vomiting or using laxatives). People with anorexia, whom doctors sometimes call anorectics, severely limit their food intake. About half of them also have bulimia symptoms.

The National Center for Health Statistics estimates that:

• About 9,000 people admitted to hospitals were diagnosed with bulimia in 1994, the latest year for which statistics are available, and about 8,000 were diagnosed with anorexia.
• Studies indicate that by their first year of college, 4.5 to 18 percent of women and 0.4 percent of men have a history of bulimia.
• As many as 1 in 100 females between the ages of 12 and 18 have anorexia.
• Males account for only 5 to 10 percent of bulimia and anorexia cases.
• While people of all races develop the disorders, the vast majority of those diagnosed are white. Most people find it difficult to stop their bulimic or anorectic behavior without professional help. If untreated, the disorders may become chronic and lead to severe health problems, even death. Antidepressants are sometimes prescribed for people with these eating disorders.
• About 1,000 women die of anorexia each year, according to the American Anorexia/Bulimia Association.
• More specific statistics from the National Center for Health Statistics show that "anorexia" or "anorexia nervosa" was the underlying cause of death noted on 101 death certificates in 1994, and was mentioned as one of multiple causes of death on another 2,657 death certificates.
• In 1994, bulimia was the underlying cause of death on two death certificates and mentioned as one of several causes on 64 others.

The Bulimia Secret

Once people begin bingeing and purging, usually in conjunction with a diet, the cycle easily gets out of control. While cases tend to develop during the teens or early 20s, many bulimics successfully hide their symptoms, thereby delaying help until they reach their 30s or 40s. Several years ago, actress Jane Fonda revealed she had been a secret bulimic from age 12 until her recovery at 35. She told of bingeing and purging up to 20 times a day.

While normal food intake for women and teenagers is 2,000 to 3,000 calories in a day, bulimic binges average about 3,400 calories in 1 1/4 hours, according to one study. Some bulimics consume up to 20,000 calories in binges lasting as long as eight hours. Some spend $50 or more a day on food and may resort to stealing food or money to support their obsession.

To lose the weight gained during a binge, bulimics begin purging by vomiting (by self-induced gagging or with an emetic, a substance that causes vomiting) or by using laxatives (50 to 100 tablets at a time), diuretics (drugs that increase urination), or enemas. Between binges, they may fast or exercise excessively.

Extreme purging rapidly upsets the body's balance of sodium, potassium, and other chemicals. This can cause:

• Fatigue
• Seizures
• Irregular heartbeat
• Thinner bones

Repeated vomiting can:

• damage the stomach and esophagus (the tube that carries food to the stomach)
• make the gums recede and erode tooth enamel. (Some patients need all their teeth pulled prematurely)

Other effects include:

• various skin rashes
• broken blood vessels in the face
• irregular menstrual cycles

Complexities of Anorexia

While anorexia most commonly begins in the teens, it can start at any age and has been reported from age 5 to 60. Incidence among 8- to 11-year-olds is said to be increasing. Anorexia may be a single, limited episode with large weight loss within a few months followed by recovery. Or it may develop gradually and persist for years. The illness may go back and forth between getting better and getting worse. Or it may steadily get more severe.

Anorectics may exercise excessively. Their preoccupation with food usually prompts habits such as moving food about on the plate and cutting it into tiny pieces to prolong eating, and not eating with the family.

Obsessed with weight loss and fear of becoming fat, anorectics see normal folds of flesh as "fat" that must be eliminated. When the normal fat padding is lost, sitting or lying down brings discomfort not rest, making sleep difficult. As the disorder continues, victims may become isolated and withdraw from friends and family.

The body responds to starvation by slowing or stopping certain bodily processes. Here are some symptoms:

• blood pressure falls
• breathing rate slows
• menstruation ceases (or, in girls in their early teens, never begins)
• activity of the thyroid gland (which regulates growth) diminishes
• skin becomes dry
• hair and nails become brittle
• lightheadedness
• cold intolerance
• constipation
• joint swelling

Reduced fat causes the body temperature to fall. Soft hair called lanugo forms on the skin for warmth. Body chemicals may get so imbalanced that heart failure occurs. Anorectics who additionally binge and purge impair their health even further. The late recording artist Karen Carpenter, an anorectic who used syrup of ipecac to induce vomiting, died after buildup of the drug irreversibly damaged her heart.

Getting Help

Early treatment is vital. As either disorder becomes more entrenched, its damage becomes less reversible.

Usually, the family is asked to help in the treatment, which may include psychotherapy, nutrition counseling, behavior modification, and self-help groups. Therapy often lasts a year or more--on an outpatient basis unless life-threatening physical symptoms or severe psychological problems require hospitalization. If there is deterioration or no response to therapy, the patient (or parent or other advocate) may want to talk to the health professional about the plan of treatment.

There are no drugs approved specifically for bulimia or anorexia, but several, including some antidepressants, are being investigated for this use.

If you think a friend or family member has bulimia or anorexia, point out in a caring, nonjudgmental way the behavior you have observed and encourage the person to get medical help. If you think you have bulimia or anorexia, remember that you are not alone and that this is a health problem that requires professional help. As a first step, talk to your family doctor, religious counselor, or school counselor or nurse.

Suicide

Suicide is a major, preventable public health problem. In 2004, it was the eleventh leading cause of death in the U.S., accounting for 32,439 deaths. The overall rate was 10.9 suicide deaths per 100,000 people. An estimated eight to 25 attempted suicides occur per every suicide death.

Suicidal behavior is complex. Some risk factors vary with age, gender, or ethnic group and may occur in combination or change over time.

What are the risk factors for suicide?

Research shows that risk factors for suicide include:

• depression and other mental disorders, or a substance-abuse disorder (often in combination with other mental disorders). More than 90 percent of people who die by suicide have these risk factors.
• stressful life events, in combination with other risk factors, such as depression. However, suicide and suicidal behavior are not normal responses to stress; many people have these risk factors, but are not suicidal.
• prior suicide attempt
• family history of mental disorder or substance abuse
• family history of suicide
• family violence, including physical or sexual abuse
• firearms in the home, the method used in more than half of suicides
• incarceration
• exposure to the suicidal behavior of others, such as family members, peers, or media figures.

Research also shows that the risk for suicide is associated with changes in brain chemicals called neurotransmitters, including serotonin. Decreased levels of serotonin have been found in people with depression, impulsive disorders, and a history of suicide attempts, and in the brains of suicide victims.

Are women or men at higher risk?

• Suicide was the eighth leading cause of death for males and the sixteenth leading cause of death for females in 2004.
• Almost four times as many males as females die by suicide.
• Firearms, suffocation, and poison are by far the most common methods of suicide, overall.

Is suicide common among children and young people?

In 2004, suicide was the third leading cause of death in each of the following age groups. Of every 100,000 young people in each age group, the following number died by suicide:

• Children ages 10 to 14 - 1.3 per 100,000
• Adolescents ages 15 to 19 - 8.2 per 100,000
• Young adults ages 20 to 24 - 12.5 per 100,000

As in the general population, young people were much more likely to use firearms, suffocation, and poisoning than other methods of suicide, overall. However, while adolescents and young adults were more likely to use firearms than suffocation, children were dramatically more likely to use suffocation.

There were also gender differences in suicide among young people, as follows:

• Almost four times as many males as females ages 15 to 19 died by suicide.
• More than six times as many males as females ages 20 to 24 died by suicide.

Are older adults at risk?

Older Americans are disproportionately likely to die by suicide.

• Of every 100,000 people ages 65 and older, 14.3 died by suicide in 2004. This figure is higher than the national average of 10.9 suicides per 100,000 people in the general population.
• Non-Hispanic white men age 85 or older had an even higher rate, with 17.8 suicide deaths per 100,000.

Are Some Ethnic Groups or Races at Higher Risk?

Of every 100,000 people in each of the following ethnic/racial groups below, the following number died by suicide in 2004.

• Highest rates:
  • Non-Hispanic Whites - 12.9 per 100,000
  • American Indian and Alaska Natives - 12.4 per 100,000

• Lowest rates:
  • Non-Hispanic Blacks - 5.3 per 100,000
  • Asian and Pacific Islanders - 5.8 per 100,000
  • Hispanics - 5.9 per 100,000

What are some risk factors for nonfatal suicide attempts?

• An estimated eight to 25 nonfatal suicide attempts occur per every suicide death. Men and the elderly are more likely to have fatal attempts than are women and youth.
• Risk factors for nonfatal suicide attempts by adults include depression and other mental disorders, alcohol abuse, cocaine use, and separation or divorce.
• Risk factors for attempted suicide by youth include depression, alcohol or other drug-use disorder, physical or sexual abuse, and disruptive behavior.
• Most suicide attempts are expressions of extreme distress, not harmless bids for attention. A person who appears suicidal should not be left alone and needs immediate mental-health treatment.

Tap Water Scalds

Each year, approximately 3,800 injuries and 34 deaths occur in the home due to scalding from excessively hot tap water. The majority of these accidents involve the elderly and children under the age of five. The U.S. Consumer Product Safety Commission (CPSC) urges all users to lower their water heaters to 120 degrees Fahrenheit. In addition to preventing accidents, this decrease in temperature will conserve energy and save money.

Most adults will suffer third-degree burns if exposed to 150 degree water for two seconds. Burns will also occur with a six-second exposure to 140 degree water or with a thirty second exposure to 130 degree water. Even if the temperature is 120 degrees, a five minute exposure could result in third-degree burns.

The CPSC notes that a thermostat setting of 120 degrees Fahrenheit (49 degrees Celsius) may be necessary for residential water heaters to reduce or eliminate the risk of most tap water scald injuries. Consumers should consider lowering the thermostat to the lowest settings that will satisfy hot water needs for all clothing and dish washing machines.

Never take hot water temperature for granted. Always hand-test before using, especially when bathing children and infants. Leaving a child unsupervised in the bathroom, even if only for a second, could cause serious injuries. Your presence at all times is the best defense against accidents and scaldings to infants and young children.

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