ANOREXIA, BULIMIA AND PSYCHOGENIC OBESITY
in collaboration with Aba 
Association for the study and research on anorexia, bulimia, obesity and eating disorders
In Italy about 3 million people (5% of population) suffer from eating disorders. Anorexia, bulimia and psychogenic obesity are severe pathologies that damage the body and represent three different ways of expressing a personal deep disease. The causes of these pathologies are not totally known. Affection losses, abandonments, traumatic events are often associated to these disorders, being the causes of severe sufferings for both the person affected and their family. For a long time the scientific literature has defined these pathologies as “feminine”, since women are the most affected. Today instead, it has been found that also men are affected, from childhood to adult age.
- The phenomenon
- Some figures
- Feminine pathologies
- Anorexia
- Bulimia
- Psychogenic obesity
- The causes
- The effects on the body
- Social impacts: family, study, work, social relations
- The central role of family
- Family and friends: what to do and not to do
- Treatments
- How to recover
- Who can help
- Manifestos against anorexia
1. The phenomenon
Anorexia, bulimia and obesity are sever pathologies that exploit the body to express deep suffering. The body is filled up and emptied, it gets thin and gets weight until exploding: this is the visible sign of severe psychological diseases that represent the real suffering, therefore they should be understood and treated as such. Anorexia, bulimia and obesity are severe psychological diseases, and not appetite disorders. These pathologies can be represented as an iceberg. The visible top in anorexia is characterized by rejecting food, counting the calories obsessively and by hyperactivity. In bulimia, it is characterized by repeated binging followed by auto-inducted vomiting. In obesity, it is characterized by a bottomless and continuous intake of food that causes a consistent increase in weight. The submerged part of the iceberg, that is not visible, is where all the individual problems, experiences, emotions and pain lie. Seeing only the visible part, the top, of anorexia, bulimia and obesity, means ignoring the core of the problem.
2. Some figures
In Italy about 3 million people (5% of population) have to cope with eating disorders, and 8-10% of young women and 0.5% of young men suffer from anorexia and bulimia. Over 3% of the population, an increasing number, present a confirmed case of anorexia-bulimia. 95% of them are women, although men manifesting these symptoms are increasing and asking for specialized assistance. These pathologies manifest between the ages 12 and 25 mainly. In the last period there has been an alarming widening of the age that particularly affects young girls in the pre-puberty phase and women in menopause.
3. Feminine pathologies
Over 90% of those who suffer from these diseases are women. The explanation must be searched in the problematic relationship that they have with their body, their own identity and self-esteem. Women have a more conflict relationship with their body than men. Anorexia, bulimia and obesity are often pathologies that recognize a problematic relationship with the parental figures, in particular with the mother; they are pathologies of separation: the mother and the daughter struggle to build a separated identity as women tend to remain stuck in the relation mother-daughter.
4. Anorexia
Anorexia manifests through a dramatic reduction of food and body weight. The anorexic person denies hunger, which is controlled tenaciously. Actually the anorexic is desperately hungry, but not just of food. They are hungry of everything: relationships, affections, emotions. For this reason, they refuse everything. It is by rejection that they look for an illusionary autonomy from every need and desire. Anorexia begins from a diet to improve the look. The anorexic person pursuits an ideal thinness which is unreachable, and towards which they always feel inadequate. So the diet never ends, the thinness achieved is never enough. In spite of the extreme thinness, the body always is felt as fat, such phenomenon is called “misperception of the body image”, and it occurs when the person sees their image through a mirror. In anorexia, the top of the iceberg is evident, and it shows a starved and skinny body that evokes a sense of death and causes anguish even in those who cure. The fast in anorexia seriously compromises the vital functions. The anorexic person lives in the illusion that changing the body means changing the life. The body becomes like a stage where an unspeakable pain is played. Anorexia is also a control pathology. The anorexic subject, in order to ignore the emotions and relations that they cannot control, looks for a balance in the illusory control on food-body-weight. In the recent years it has been found that in 40% of the cases of anorexia also bulimia is present.
5. Bulimia
Bulimia has all the characteristics of the dependence pathologies. In this case, the object of dependence is food. The bulimic person swallows huge quantity of food (even raw, or frozen, or rotten, or stolen) which they throw up soon, even many times a day. They would like to reject everything, as in anorexia, but they cannot. They eat and throw up “everything and everybody”, for years, without being seen, along with a collapse of self-esteem, and an unbearable sense of guilt. The effects of these practices are severe on the digestive apparatus, esophagus, teeth and hair. The body is badly treated with anger. The bulimic person often has a normal weight. Bulimia is not as visible as anorexia. The severity of bulimia is still disregarded and underestimated. The daily economic cost to maintain the bulimic crises is very high for families. A bulimic person can even spend up to 200 Euros per day to satisfy their needs.
6. Psychogenic obesity
Psychogenic obesity, differently from the so-called simple obesity, is based on important psychological factors.
Only rarely it is a consequence of metabolic malfunctions.
In psychogenic obesity, the person develops a food addiction with different modes from bulimia.
The obese subject takes huge quantities of food, without vomiting it, and they often select it accurately.
The body fat seems to be a sort of barrier to protect themselves from emotions and relations, and to put a virtual distance between themselves and the others. The obese children and adolescents in particular are often victims of derision by their coetaneous, being unable to defend themselves.
This will be the cause for depression and a consequent increase of obesity.
7. The causes
The causes of the pathologies anorexia-bulimia and psychogenic obesity are multiple: they are causes far from a present suffering, but dated back in time and in the family where the person was born and brought up.
That is often a family where food has been the main answer to the needs for a cure and love.
The obsessive thought of food is stuck in the mind and life of those who suffer from anorexia, bulimia and obesity.
This seems to be a solution, a self-cure not to think, the symptom turns into a tool to cope with existence difficulties.
These subjects often suffer from the loss of an important person, or being abandoned, or abused at a very young age by either a family member or a close friend.
In anorexia, bulimia and obesity, food turns into an anesthetic that enables not to feel the pain, but that prevents from living the life fully.
8. The effects on the body
Anorexia, bulimia and obesity affect the body severely. Malnutrition and auto-inducted vomit cause permanent damages to the digestive apparatus and teeth. Dehydration and hypokalaemia can damage the heart.
In anorexia, in particular, both the loss of weight and the psychological problem with femininity can cause amenorrhoea (the absence of menstrual period) that, if it remains for many years, can cause precocious osteoporosis (decalcification of the bones).
In obesity, cardio-circulation, osteo-arthro-muscular, and metabolic (diabetes) pathologies pose a sever risk to the subject’s good health.
Also memorization and concentration skills risk a damage.
The person can die from anorexia, bulimia and obesity. When the anorexic-bulimic pathology and obesity are precocious and last for long time, the emotional disease and the damages are more severe.
The prevention activity is fundamental: it reduces the risk of insurgence of these severe pathologies, it anticipates the beginning of a treatment and it limits the risk of chronic.
In the last years, it has been found that anorexia, bulimia and obesity often hide other psychiatric pathologies and pathological addictions.
9. Social impacts: family, study, work, social relations
The eating disorders have high social costs. Such costs do not only impact the National Health Service expenses, but they also impact the families and the person in terms of relationships, experiences and social functioning. The people who suffer from eating disorders tend to close themselves, to isolate and exclude the others from their life. Families above all have to manage very difficult situations, often feeling unable to. The person finds everyday activities very hard: in a life regulated by food, it becomes difficult to go to work, or study, or go out, or take care of the house or their own needs.
10. The central role of family
The anorexic-bulimic disorder and obesity manifest in adolescence, but their roots date back in childhood. Parents are the centre of wellbeing and disease of their own children. Parents are often unaware of their own unsolved psychological diseases: often silenced, they might have contributed to the insurgence of the disease in their children. Anorexia, bulimia and obesity are diseases that create disorientation and pain within the family. Parents in particular fell confused, scared and impotent, with feeling of guilt and loneliness. For this reason it is fundamental to provide them with a treatment that could re-balance the family relationships.
11. Family and friends: what to do and not to do
Family and friends are deeply involved into the tragedy of anorexia, bulimia and obesity. Anorexia, bulimia and obesity are not a whim, but psychological diseases and not malnutrition problems. It is important to listen to them without judging, respecting space and time of those who suffer avoiding to force them to eat. It is also important to know that family and friends cannot cure those who suffer from anorexia, bulimia and obesity. They can find specialized centres and convince the person to accept the treatment. In a lot of centres there are specific programmes for families aimed at helping and providing them with the necessary tools to face the cure. These are like listening and/or cure centres conduced by professionals to whom the family can address their questions about the children’s pathology. This type of treatment, if accepted by the family of the person that rejects it, can really help. The family member, that accepts the parallel treatment to help their own child, must be, ready to discuss and criticize their relationship with their child and the other family members. That will make them aware of the existence of a problem in the relationship between parents and children, without feeling guilty.
12. Treatments
It is possible to recover from anorexia, bulimia and obesity. Besides the recover, sometimes necessary to enable the person to cure a compromised physical condition, there are several treatment programmes to choose. The choice only depends on the person, their characteristics and history. It not possible to recover on their own, but it is necessary to rely on professionals in appropriate and competent centres. There are places where therapists and specialized doctors operate: local health units, consultancy centres, hospitals, associations and residential centres. By dialling the help-line 800.16.56.16, it is possible to receive information about the closest ABA treatment centres and the most accredited public centres for the cure of these pathologies.
13. How to recover
A deep self-motivation is required to recover.
The recover itself is mediated by the person’s will to change their own situation, posing an end to their suffering.
It is necessary to rely on professionals of eating disorders treatments.
The treatment program is often long, as long as the time between the insurgence of the symptom and the decision to get cured.
There are different therapeutic approaches. Psychotherapies and integrated psychoanalysis-orientated treatments focus on the causes: they try to give the subject a listening space that enable them to express their unspoken conflict, only visible through the body.
The stress is put on the submerged part of the disease, but this treatment is also integrated with the cure of the body and the related potential psychopathologies. On the contrary, the behavioural and re-educational approaches focus mainly on the visible effects and food re-education. In this case, the body is the centre of the cure aimed at regaining weight and reactivating a correct nutrition.
14. Who can help
Contact: the family doctor, the local health units, the consultancy centres and the local hospitals to be forwareded to the department or the specialized centre for eating disorders.
Project “Girasole” (Sunflower) for Eating Disorders
Pediatric Hospital Bambino Gesù - Irccs Rome
H.U. of Child Neuropsychiatry
Telephone consultancy 24h/24, 7/7, tel. 06 68592265
e-mail: girasole@opbg.net
www.ospedalebambinogesu.it
ABA - Association for the study and research on anorexia,
bulimia, obesity and eating disorders
help-line 800.16.56.16
www.bulimianoressia.it
Moige - Movimento Italiano Genitori (Italian Parent Movement)
www.genitori.it
www.anoressiaebulimia.info
15. Manifestos against anorexia
ITALIAN FASHION NATIONAL MANIFESTO OF AUTOREGULATION VERSUS ANOREXIA
Sponsored by
The Ministry of Youth and Sports
National Chamber of Italian Fashion
Alta Roma
Given that
Eating disorders, like anorexia and bulimia, affect about three million people in our country. These are individuals who suffer from a serious disorder of the psyche, an insidious disease whose unknown causes are often originated in difficult lives.
The problem is complex to be dealt with, and it requires the intervention of specialists, such as nutritionists, psychiatrists and psychotherapists.
A lot of women suffering from eating disorders are young who have started
a diet in order to attain the ideal of fashion shows and models provided by the press. They want to follow a model of aesthetic beauty perceived as the right one.
We are aware of the fact that young people can be influenced by models and
lifestyles in which an extreme thinness becomes a model to emulate.
We believe that this cultural and aesthetic component coming from the media is according to the specialists only an environmental co-cause of a clinical psychiatric distress rooted in the history of the individuals suffering from eating disorders. But this is a co-cause we do not want to underestimate.
Given that
from the scientific researches and statistics on anorexia it results that:
- people can die from anorexia and bulimia (source: ABA );
- anorexia is the major cause of death from psychiatric disease (source: ABA)
- about 3% of the population have a problem of anorexia or bulimia (source: ABA)
- 95% are women (source: ABA)
- albeit indirectly and secondarily, models as socio-cultural factors that enhance the beauty of fashion icons of thinness are contributing to the onset of eating disorders (ABA, AED , AIDAP )
- the negative influence of aesthetic "anorexic" models has also an impact on pre-
adolescence: 60.4% of Italian girls aged between 12 and 14 develop a desire for thinness, 24% have already been on a diet, 34% have followed their own diet without consulting a doctor (source Italian Society of Pediatrics);
- according to the World Health Organization, there are a number of indicators
to determine the health of an individual, including the Body Mass Index
(BMI); moreover, according to the WHO, a BMI below 18,5 is an alarming sign that clearly indicates an underweight state, and that should be measured by tools through which it is possible to establish the state of health of an individual.
[See attached]
****** ******
Given the above
Based on this evidence, fully aware of the role of responsibility we have, the Italian Government, and particularly the Minister of Youth, the National Chamber of Italian Fashion, and Alta Roma intend to transmit positive aesthetic models as a practical means of eating disorders prevention.
Therefore:
1) We are committed to rebuilding a model of healthy and Mediterranean beauty, which Italy has historically contributed to spread worldwide. We believe that it may still be a good aesthetic model for both the Italian women and those from around the world.
2) We are committed to protecting the health of fashion models by asking them to provide a medical certificate based on the assessment of the scientific and diagnostic criteria regarding eating disorders (including BMI). Therefore we are committed to
banning models whose medical certificate should prove the evidence of an eating disorder.
3) We are committed to banning models under the age of 16, because we believe that they are not ready yet for the world of professional fashion, which may give their peers a wrong message in the delicate phase of pre-adolescence.
4) We are committed to promoting through our associations and fashion companies the sizes 46 and 48 in their collections because we believe that the attempt to develop a more prosperous aesthetic model is not only important from a cultural and moral point of view, but also from a productive commercial point of view.
5) We are committed to supporting the institutions and the medical associations specialized in promoting campaigns to change positive aesthetic models that inspire the formation of identity and the social behaviour.
6) We are committed to providing our internal regulations appropriate measures to ensure compliance with the principles expressed in this manifesto.
We hope adherence to these commitments by all operators in the fashion industry, such as designers, model agencies, photographers and make up artist.
****** ******
This Manifesto is binding on those who subscribe.
_addload(function(){_setupIW();_csi('it','en','http://www.egomodelmanagement.it/images/Manifesto%2520Moda_anoressia.pdf');});
The Ministry of Youth and Sports
on. Giovanna Melandri
National Chamber of Italian Fashion
Mario Boselli
Alta Roma
Stefano Dominella
Rome, December 22nd, 2006
ATTACHMENT
The body mass index (BMI) is a measure of body weight based on a person's weight and height. It is the most widely used diagnostic tool to identify weight problems within a population, usually whether individuals are underweight, overweight or obese. Though it does not actually measure the percentage of body fat, it is used to estimate a healthy body weight based on a person's height, assuming an average body composition. Body mass index is defined as the individual's body weight divided by the square of his or her height. For example, if a person weighs 70 kg and is 1.75 m high, the body mass index is 22.9.
BMI = 70 (Kg) / 1.752 (m2 ) = 22.9