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Attacking eating disorders from inside out by Chris West Public Relations Many of us would say that the solution to eating disorders is to just eat.  The truth is that in most cases the real problems lie beneath the surface leaving the patient in need of more than just simple nourishment. Anorexia nervosa, bulimia nervosa and binge eating disorder (BED) occur predominantly in young women, but no age group or gender is immune. “I have seen cases involving children as young as eight and in elderly women,” said Timothy Brewerton, M.D., of the Institute of Psychiatry and director of the Eating Disorders Program. “Some ratios reach 10 to one, women to men, as is the case with anorexia.” “If it doesn’t kill you, it will maim you,” Brewerton said. “There is no drug for anorexia except food.” It has been found to permanently damage the bones, causing osteoporosis and osteopenia(decreased bone mass), and has resulted in loss of gray matter in the brain that does not return with weight gain. “It is the most lethal disorder we treat,” he said. The rates of occurrence for the three disorders are varied; “0.1 to 0.8 percent of American women have anorexia, making it fairly rare, two to three percent of American women show signs of bulimia, and another one percent exhibited signs of binge eating disorder,” he said. The rates at which the disorders occur may seem strikingly low, but many cases go unreported or the actual disorder itself may not be fully apparent. “Many patients exhibit multiple symptoms of the disorders but may not have the full-blown illness,” Brewerton said. “According to the National Women's Study, conducted on more than 3,000 women, 24 percent admitted they had participated in eating disorder symptoms, yet were not diagnosed as having the full illness.” If left untreated any disorder can become a cycle that gradually tears the body down by going through the destructive motions of the disorder. “Patients will starve themselves early in the day, skipping breakfast and lunch then go home at night and are famished, so they overeat to compensate,” Brewerton said. “Then in that state of hunger, and with such a low metabolism, they gain weight, notice this and begin to purge to get the weight off, hence the cycle.” Treatment of disorders varies among the patients seen and must take place in stages. Some disorders require longer and more intensive treatment than others and may even stretch over several areas of medicine.  “Eating disorders can apply to literally every system of health care,” Brewerton said. “Almost every school of medicine may have seen patients in the past that complain about a particular symptom that they are suffering from that is related to one or more eating disorders without the disorder ever coming to light.”  “Nutritional rehabilitation is primary because a starved brain can’t learn,” Brewerton said. “So eliminating starvation must come first and then we address the other relative problems.” This involves refeeding and bringing the patient under a stable meal plan, then various other therapies take place to combat the disorder in other areas of their lives.  Behavioral and family therapies may be incorporated to get to the root of the problem. “But cognitive therapy in the patient is paramount,” Brewerton said. Due to the phasic nature of treatment and the presence of multiple risk factors and symptoms within the disorders, treatments are usually long and difficult because, according to Brewerton, “the causes present themselves in three areas: biological, psychological and in the area of social context with many of these risk factors overlapping into more than one area.” The risk factors are also categorized into one of three areas of manifestation. They are either predisposed genetically, precipitating factors or perpetuating factors. “This makes treatment difficult in that there is never just one reason or cause for a disorder,” Brewerton said. “Above all, food is medicine, not the enemy, for all patients with eating disorders,” Brewerton said. “Even though some antidepressants have helped prevent relapse in anorexia and in bulimia and BED coupled with psychotherapy, we have no magic bullets to fight these conditions. They simply must be fed and there is no substitution.”