Mental problems often go with eating disorders

EDITOR’S NOTE: This article is the third in a weeklong series that examines eating disorders at the University. Thursday’s article focuses on eating disorders in the gay, lesbian, bisexual and transgender community.

Elena Rozwadowski

While in high school, Megan Kosse was a straight-A student with a flair for debate.

But she never felt like that was good enough.

“I would tell my mom that whatever I did was mediocre,” said Megan, an anthropology and Spanish junior. “I felt like trying to compensate.”

She started taking diet pills and restricting her food to try to gain control of her body and her mind. Sometimes she would binge eat to make herself better.

When Megan got to the University, the binge eating increased.

“I remember hitting all the milestones ñ- 5, 10, 15 pounds heavier,” she said.

At one point, she started cutting her stomach to deal with the depression and anxiety.

“It took the focus off. It was the only thing that could make my mind stop,” she said. “That’s all I wanted to do in the first place.”

In the world of eating disorders, Megan’s situation is not unusual.

Diann Ackard, a private-practice psychologist in Golden Valley who specializes in eating disorders, said the disorders can serve as a distraction from other mental health problems.

“Eating disorders can help numb intense feelings,” Ackard said. “It’s like an ‘anesthesia’ for emotions.”

With help from her mom, Megan made an appointment at the Service for Teenagers at Risk Clinic for Family Health in the McNamara Alumni Center, where she was given medication for her depression and anxiety.

“I always thought binge eating wasn’t a big deal; it was just my form of a diet,” Megan said. “But you can die from it.”

A common problem

Depression and anxiety are two of the more common mental health problems that accompany eating disorders.

In fact, 50 percent to 75 percent of patients with anorexia or bulimia have problems with depression, according to the American Psychiatric Association.

Depression can often cause eating problems, said Candice Price, a clinical social worker at Boynton Health Service.

“When you see someone for depression, they may have an issue with food, meaning they may have lost weight because they’re not eating because they’re depressed,” she said. “There’s overlap, but the eating disorder is not necessarily a given.”

Other internal and external factors can trigger the disorders, Ackard said.

“There are genetic components involved and there are also environmental components involved,” she said. “There is a genetic predisposition for many individuals who have eating disorders, but it seems the environment has to play a role in triggering those genes to activate.”

Other common issues include obsessive-compulsive disorder, bipolar disorder and different personality disorders that affect a person’s emotional reactions to a situation.

Post-traumatic stress disorder is also a common trigger for eating disorders, especially when sexual abuse is involved.

Up to 50 percent of anorexia and bulimia nervosa patients have reported sexual abuse in their past, according to American Psychiatric Association statistics.

Ackard described trauma as a “nonspecific risk factor” with eating disorders, which means trauma can make a person susceptible to many different mental health issues.

“In cases of violence to the body, the body is the site where the trauma occurred,” she said. In these cases, she said, the person may want to change their body in order to erase the trauma.

“In terms of sexual abuse in women, a woman may want to lose weight in order to revert back to what they see as the safety of a younger time,” she said.

The college environment can also trigger eating disorders from both an environmental and developmental standpoint.

According to the American Psychiatric Association, eating disorders are the third most common chronic illness to affect college women, after obesity and asthma, respectively.

Everything from the infamous “freshman 15” to the college lifestyle can trigger an eating disorder, said Carol Tappen, director of operations for the St. Louis Park-based Eating Disorders Institute.

Sometimes the pressure to fit in can be a big factor in eating disorders in the college environment.

“There’s the example of the young woman who’s always been a little heavy who gets to college and everyone around her is bone-thin,” Tappen said. “There may be bingeing and purging in the dorms or the sorority houses and that young woman gets caught up in it because she wants to belong.”

Treating the eating, treating the mind

Because mental health issues and eating disorders are so intertwined, it is often difficult to treat one before the other, Tappen said.

“Symptom interruption is huge,” she said, and one of the first goals in most treatment programs is developing a normal eating pattern.

“The key is to interrupt the cycle while the patient is clinically contained,” Tappen said.

Support from family and friends can be key to successful treatment, she said.

“Families have to be involved,” Tappen said, because a family member might need education and support when one of them has an eating disorder.

“We have to make sure nobody’s blaming themselves,” she said.

Tappen said it is often helpful for patients to pick up the phone and talk to a family member who “gets it.”

“I believe you always need two or three people that you can talk to who have said you can call them morning, noon or night,” she said.

University psychiatry professor Scott Crow said it’s often easier to treat the eating problems first because they bring so many problems with them, especially in anorexia patients.

“Starvation really tends to impact thinking,” he said.

The mental health problems can often be the most problematic parts of treatment, Crow said.

“Unless you can reverse the anorexia at least a little bit, it can be almost impossible to treat the other problems,” he said.

One of the biggest problems with treatment is each patient’s differing needs.

“The diagnostic criteria don’t work very well,” Crow said.

Many people will be diagnosed as anorexic and a few months later, show symptoms of bulimia, he said.

“The reason you group people together is to better make predictions,” Crow said. “That’s something we can’t do with as much confidence when it comes to eating disorders.”

Collecting data to take steps

To better understand eating disorders, the University psychiatry department is conducting a study on anorexia.

The study, funded by the National Institute of Mental Health, will analyze anorexia symptoms as they happen. Forty individuals with anorexia will use a hand-held computer, similar to a Palm Pilot, to record their symptoms. Subjects will carry the computer for two weeks.

Researchers are starting to collect test subjects for the study and will continue to do so for the next two years, Crow said.

“The advantage of this particular study is that it measures symptoms at the time they happen, rather than asking a patient about them three weeks later,” he said.

Eventually, Crow said, the department hopes to develop new treatments from this data.

“You’re more able to do that when you better understand the symptoms,” he said.

One day at a time

Megan has been on and off of antidepressants to help control her binge eating since she started treatment two years ago. She had the eating habits under control for a while, but the stress of fall semester put her back on the pills.

Though it took some time, Megan is now comfortable taking antidepressants.

“I viewed them as a crutch,” she said. “I didn’t want to live my life taking meds.

“I decided I would much rather just be happy; I have to live with my thoughts every day.”