Binge eating, bulimia nervosa, compulsive overeating and anorexia nervosa are different types of eating disorders and are often a reaction to external and internal conflicts. They are affected by a complex mixture of social, psychological and physical problems. The disorder may appear after the death of someone close, or if the sufferer is going through a period of extreme stress.

Victims of binge eating consume large quantities of food in a very short period of time until they feel uncomfortably full. Unlike bulimia, binge eating victims do not use any form of purging like vomiting, laxatives or fasting. They usually feel out of control during a binge eating episode, followed by feelings of guilt and shame.

On the other hand, bulimia is a cycle of binge eating followed by purging to try and rid the body of unwanted calories. A binge depends on the individual, and the calorific intake can vary from 1,000 to 10,000 calories. Purging methods include vomiting and laxative abuse, excessive exercise, fasting, use of diuretics, diet pills and enemas.

Compulsive eating is characterised by uncontrollable eating and consequent weight gain. Victims use food as a way to cope with stress, emotional conflicts and daily problems. Compulsive eating usually starts in early childhood when eating patterns are formed. Most people who become compulsive eaters are people who never learned how to deal with stressful situations, or people who have been victims of sexual abuse. Being overweight acts as a protective shield against outsiders and keeps people at a distance.

Anorexics have a constant fear of gaining weight. When they look in the mirror they always see a fat person, even when their weight is much less than that of other people of the same age, build and height. One of the main issues of anorexia nervosa is about control. Anorexics feel the urgent need to control their weight and their emotions to compensate for situations they don’t have control over.

The clinical description used is the person’s refusal to maintain body weight at or above a minimally normal weight for age and height – most clinicians use 85 per cent of normal weight as a guide.

Another characteristic is the cessation of the menstrual cycle for at least three months, and a decreased sexual drive in men. Even when seriously underweight, the sufferer still has an intense fear of gaining weight or looking fat. An anorexic person is never satisfied with her/his weight – there are always a few more kilograms to lose. What they actually lose is their sense of perception.

Psychologically, anorexics often suffer from depression and attempt suicide. On the physical side the long-term effects include osteoporosis, damage to the heart, liver, kidneys and brain. If the sufferer is very young, it can impede growth and cause difficulties in concentration. If not treated, anorexics can become chronically ill or die.

Unless one is aware of the symptoms it is difficult to know when a person is suffering from anorexia nervosa. The most common signs are periods of starvation, obsessive counting of calories, compulsive exercising and purging after meals.

However anorexics will go to extreme lengths to deny they have a problem, and become ingenious at hiding evidence that would expose their illness. They deny they are hungry, make excuses to avoid eating, hide food they say they have eaten or attempt to get rid of the food through self-induced vomiting, or by taking laxatives.

It is difficult to estimate the extent of the problem, but it is calculated that up to one per cent of schoolgirls and female university students suffer from anorexia nervosa and affects about one in 2,400 adolescents – 95 per cent are women. There is a possibility that these numbers are on the increase.

Eating disorders usually affect women between 10 and 25 years of age. It usually starts in the teenage years when the adolescent becomes more conscious about body weight and appearance. Certain professions such as modelling, gymnastics and ballet dancing where weight and personal appearance is vital are at risk. The illness is mainly found in the western world and is almost non-existent in Asia and Africa. People who are perfectionists and high achievers also seem to be those at risk.

One of the reasons given for eating disorders is that they often are portrayed to be a direct effect of the skeletally slim models and actresses in the fashion and entertainment industry. Feminists in particular have criticised this. They believe that the main cause is not their actual weight and appearance but the need to be attractive to men.

There is no effective treatment. Treatment varies according to the patient’s circumstances and aims to restore the person to a healthy weight through healthy eating patterns. It is also important to know the sufferer’s thoughts and beliefs about food and body image as well as any physical complications or associated mental health problems in order to treat their ailment.

In certain cases, medication is necessary, especially where there is depression or serious compulsive symptoms. Treatment by a psychologist or psychiatrist experienced in eating disorders would also be helpful. If the anorexic is willing to overcome the problem, there is a good 60 per cent chance of recovery.

It is difficult for a family to realise and accept that their child suffers from an eating disorder. It is even harder for the anorexic to accept s/he has a problem. The family often feels that the child is attention seeking or just a momentary phase the child is going through. Siblings may feel left out or jealous of the extra attention the parents are giving the sufferer without understanding the depth of the problems. Statements complimenting the anorexic on her weight will often lead to a further obsession to lose a few extra kilos.

One of the most important factors for the victim’s recovery is the family’s unconditional support and empathy. Unfortunately, the family is often confused and in need of support in order to help the child. It is important to have support groups and structures which will help the family structure remain solid. The tension and isolated feeling would be greatly minimised knowing there are other families in the same situation.

Last year, the Health Department organised a campaign entitled Eating Disorders Awareness Week, promoting awareness in schools. Special emphasis was made on healthy eating and the importance of physical exercise in primary schools.

In Malta there is a total lack of support groups for victims of eating disorders and their families. There has to be a constant campaign to provide information to the public, especially schools, for long-term results.

There are thousands of websites on the Internet which carry important information on eating disorders. In the UK, there are support groups where one can exchange information, experiences and tips.

Several websites offer chatrooms which are open 24 hours. One such website which also offers professional advice is:http://www.healthyplace.com/Communities/Eating_Disorders/Site/comm_calender.htm