fishy.org//), and, lastly, a list of treatment programs for serious eating
anorexics usually have additional psychological and interpersonal
problems beyond the abnormal eating. They often have poor social
skills and are frequently in conflict with family members. Young bulimic
women tend to be dependent and have trouble separating from their
mothers. Judi Hollis (1994) says she has never met a starving or
bingeing woman who wasn't raging inside, usually at her mother.
Serious eating disorders require professional treatment.
People with eating disorders need to learn better communication
and problem-solving skills and, then, change their eating-exercise
habits, such as having regular meals that include previously avoided
foods, learning new ways of handling the bingeing-purging situations,
and modifying their attitudes towards their shape and weight (see the
previous section in this chapter). This usually means therapy. Thus far,
the cognitive-behavioral methods are only fairly effective with bulimia
by persuading the patient to stop dieting since bingeing is a natural
reaction to starving the body (Wilson, 1993). Also, after the binge-
purge cycles stop, the person needs to cognitively accept his/her
"natural weight," based on healthy food and exercise. Keep in mind,
serious eating disorders are remarkably resistant to change; only half
of patients in treatment will be fully recovered in five years (American
Journal of Psychiatry, 1997, vol. 153). Like all long-term disorders,
bulimia and anorexia place great stress on the family; they all may
need help (Sherman & Thompson, 1997). Unfortunately, the
prevention programs for young at risk women have, thus far, not been
effective. These urges are hard to change.
There are many additional sources of help. See Bennion, Bierman
& Ferguson (1991) for a factual discussion of weight control. Parents
worry about their children's weight too; there is help (Archer, 1989).
Perri, Nezu, & Viengener (1992), Epstein, et al (1994), and Brownell &
Wadden (1992) provide therapists with guidelines for managing
serious obesity. For information and referrals about anorexia and/or
bulimia, call 847-831-3438. For more information about locating
Cognitive-Behavioral therapists, call 212-647-1890 or try the Web site
for ABCT (http://www.aabt.org/. All obese people and persons with
an eating disorder should have a psychological or psychiatric
evaluation, including an assessment of the family. Most importantly,
you must realize that extreme anorexia, called "the fear of being fat,"
can be fatal (5% die, half from complications and half from suicide);
don't put off getting professional treatment for anorexia and bulimia,
three-quarters can be helped by behavioral therapy. See eating
disorders at the end of the next chapter.