Anorexia, bulimia, anorexia: gram for gram: so hard is the fight against an eating disorder

When children suffer from anorexia or bulimia, their parents quickly reach their limits. The road to normal eating behavior has sometimes been long. Very few people manage to do it alone. But before help is accepted, the disease is usually already too pronounced. The fight is getting harder.

Emma K. is a pretty young girl with long blond hair and blue eyes. The 12-year-old comes from a small town in the Osterzgebirge mountains, about 50 kilometers from Dresden. At high school she is one of the best, after the vacations follows class 7.

She knows what she wants to be when she grows up. "Educator", she says. Emma seems like a carefree child on the cusp of becoming a teenager. But there is the secret fear of the scale. Every week she shows how Emma is doing. The girl has been suffering from anorexia, anorexia for about two and a half years.

It’s not always just about being thin

The desire to be slimmer than others didn’t play a role in Emma’s case, her mother believes. The girl herself cannot remember a concrete trigger – or conceals it. "Emma had no problem with her appearance", is Mrs. K. safe. With a birth weight of more than 4000 grams and also later they are a "pithy child" been. Problems would have set in during school: "Maybe it was stress-related. Emma is a perfectionist, always wants to perform well and may have put herself under too much pressure."

In the fall of 2012, the mother realizes that something is wrong with her daughter. "At first one does not want to admit it. You think they’re fluff, they’ll go away too." At first, she and her husband tried to solve the problem on their own: "But at some point, you reach a point where you can’t do it anymore. I dreamt about it at night and got scared that my child would starve to death." The pediatrician did not recognize the disease. "We had set ourselves a limit: When Emma reaches 28 kilograms, she has to go to the clinic.", tells Mrs. K., who still have two daughters.

The body as an outlet

The low weight affects the treatment at the beginning

The point was quickly reached. The girl came to the special ward for eating disorders of the child and adolescent psychiatry department at Dresden University Hospital as an emergency case. She stayed on the ward for eleven weeks, the first week and a half of which she had to rest a lot. From then on, a behavioral therapy program applied to her.

"At the beginning of treatment, our patients are often severely impaired due to their severe underweight. Constant circling of thoughts around issues such as food and weight, as well as a constant urge to move, are often agonizing for sufferers and their families. That’s why we help with a lot of decisions or even give guidelines", explains clinic director Veit Roessner. There are limits so that patients can concentrate on therapy: There is a cell phone or free exit only when the weight increases.

Gain at least 700 grams per week

Girls and boys should gain at least 700 grams a week, but no more than 1.5 kilos. Then, step by step, they are given more responsibility, for example, in choosing the portions of food they eat. When a certain weight limit is reached, sports are added back in as well. The support of the group helps. "A good group dynamic sometimes works wonders", says Roessner.

After the ward, the K family. a group therapy in the family day clinic. Up to six families share a similar fate there; care is provided individually or together. Many conversations are recorded and evaluated on video. The participants can also comment on other children: "That sometimes moves more than if we say the same thing a hundred times", Roessner emphasizes. He makes it clear to the parents that they must remain loving but consistent: "A child must also remain seated at the table for 10 minutes."

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Goals are measured by weight

Family K. used the offer only for a short time. Because Emma was the youngest in the group, her mother was worried that the situation could get worse in contact with the older children. "They were just talking about whether they could still show themselves in the swimming pool in a bikini", remembers the girl.

Emma has now been in treatment with psychotherapist Cornelia Zimmermann for a year and a half. It’s that time again on a rainy Tuesday. Emma came with her mom to talk about the past few weeks and set new goals. These are measured primarily by weight. For this day, 45 kilograms had been set. Zimmermann begins each session with weighing and measuring. What Emma weighs in is not yet enough. 300 grams missing, so she has to do without her cell phone for the time being. The consequences were agreed upon beforehand. More freedom is given when goals are reached.

"We are not yet where we want to be."

Since Emma has recently grown significantly, the minimum weight required has to be redetermined. Attention is paid not only to age and size, but also to individual weight development during the periods without eating disorders. At 1.62 meters tall, Emma should actually weigh 47 kilograms – so now the new target is: "We’re not where we want to be yet. As you are growing, you need more. Your body needs strength", makes Zimmermann clear to the girl.

The one-hour session is all about eating, but also about self-awareness and body image. The therapist and Emma talk about everyday life, whether Emma sleeps well, if she is afraid of something, what her hobbies are. The girl loves soccer and likes to exercise. Zimmermann also makes a connection here: "You can’t move more until you gain weight." The therapist advises her to always have a muesli bar or trail mix with her: "It’s important to spread the food out evenly throughout the day so that you don’t fall into any holes. You take responsibility for your food."

Eating disorders are among the most common illnesses among adolescents

Eating disorders are among the most common illnesses among adolescents and young adults, says Professor Ulrich Voderholzer. He heads the Schon Klinik Roseneck on Lake Chiemsee, one of the largest facilities in Germany for the treatment of such disorders. "Risk factors include anxiety, insecurity, low self-esteem, strong achievement orientation and perfectionism. Triggers are often a diet as well as negative remarks of important reference persons over figure and appearance." The ideal of slimness in society also plays a role.

Estimates of how many people in Germany are affected vary widely. Voderholzer estimates that there are 200,000 to 300,000 anorexics and 500,000 other patients.000 to 700.000 people with bulimia (binge eating disorder). Anorexia and bulimia are still rare among children. In puberty, however, there is a sharp increase, with one in 100 young people affected. The KIGGS children’s health study has shown that just under 15 percent of boys and just under 30 percent of girls exhibit conspicuous eating behavior.

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The families of those affected talk a lot about nutrition

One of the world’s largest collections of data on the condition can be found at the Center for Eating Disorders in Dresden. Professor Stefan Ehrlich is the head of the department and has noticed that in affected families there is often an above-average amount of talk about food or diets: "There are children who don’t want to be like their parents. Or they want to be the best at dieting." It is also a matter of finding something in which one is better than others.

Media formats and industry can push the desire for an ideal figure. According to Ehrlich, far more girls than boys are affected. Their share is currently only three percent – but with an increasing tendency. And experts note another trend: patients are getting younger and younger. This is primarily related to the earlier onset of puberty. In Dresden, even three- and five-year-olds are already being treated. Ehrlich reports about a five-year-old girl who only ate pudding.

The number of affected teenagers has doubled in recent years

The Barmer Ersatzkasse in Saxony recently published alarming figures after evaluating its own data. According to the report, the number of affected teens nearly doubled from 2009 to 2014. Even at age 50+ there was an increase of 20 percent. "Triggers for this can be serious life crises, the changed body after a birth, years of dieting or the fear of getting older. In a youth-focused society, the fear of losing success, recognition and competitiveness grows with aging.", says Paul-Friedrich Loose, Barmer regional manager in Saxony.

The Bundesfachverband Essstorungen, an association of doctors, therapists and counselors, points to another development: the number of young people with mental illnesses such as depression, borderline or obsessive-compulsive disorders is growing. Sometimes they occur together with eating disorders. "The pressure on young people is increasing, Andreas Schnebel, head of the association, addresses a general problem.

Anorexia also affects the brain

Eating disorders are now being researched at many German universities. In Dresden, one of the research focuses on shrinkage of the cerebral cortex. Professor Ehrlich’s team found that the thickness of the cerebral cortex is greatly reduced in the acute stage of anorexia – but usually regenerates with full therapy. "The extent of the changes to the brain is very similar to the degradation processes seen in Alzheimer’s disease", Ehrlich describes the consequences of the eating disorder.

"About ten percent of patients with an eating disorder die from it or later take their own lives", says Ehrlich. About half can be cured. 40 percent of those affected tend to relapse – especially in stressful and crisis situations. Mostly eating disordered differ in behavior. Those who suffer from bulimia are often ashamed and remain on the defensive. In anorexia patients, one sometimes senses a certain pride. All social classes are affected, even though anorexia is often considered a disease of high earners.

For Emma and her parents, statistics are likely to be of secondary importance. In retrospect, the crisis has strengthened the family, says Mrs. K. After the appointment with the therapist it goes to the camping vacation. "Five noodles a week", Emma is sure. She likes them almost as much as onion sausage or crackers. After the therapy hour it goes however first times to the Shoppen. "Emma is on a very good path"), says Cornelia Zimmermann. Emma will manage.

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