Table of Contents: 1.

Abstract Anorexia become a real concern for medical institutions and social researchers, these days as it is threaten student and youth health, and lead for many others disease. given that adaptable risk factors for eating disorders have been identified and interventions have been evaluated to reduce these risk factors. The main objective of this research paper is to determine if the fashion and media can prevent the onset of eating disorders (EDs) in student at risk for developing EDs. Participants College-age women with high weight and shape concerns were recruited via campus e-mails, posters, and mass media. Six hundred thirty-seven eligible participants were identified; of student 157 were excluded, for a total sample of 480.

2. Introduction Each year eating disorders continue to be on the rise among college students. When entering college, people experience many different feelings and emotions. Some may feel excited about finally being able to start studying towards the career of their choice and feel hopeful about their future. They may be looking forward to their freedom and a chance to experience independence. They may be excited about having a chance to meet people and develop new friendships. Others may not experience those same feelings and may not be ready to enter into such an environment. The thought of being themselves and having to be independent can be very frightening. They may feel uncertain about their future and fear becoming an adult and taking on the extra responsibilities. Having to meet people and develop new friendships can also be frightening. They may fear they will not be accepted or fit in. Some may not even want to be in college. They may have been pressured into going there by their parents. All though college can be a wonderful experience for people, for some, it can be one of the worst. Or the right thought, that they become under the pressure of "Model" in media that provided by Fashions designers? In this research paper we are going to reveal up the fact behind Anorexia among students.

Each year eating disorders continue to be on the rise among college students. When entering college, people experience many different feelings and emotions. Some may feel excited about finally being able to start studying towards the career of their choice and feel hopeful about their future. They may be looking forward to their freedom and a chance to experience independence. They may be excited about having a chance to meet people and develop new friendships. Others may not experience those same feelings and may not be ready to enter into such an environment. The thought of being on their own and having to be independent can be very frightening. They may feel uncertain about their future and fear becoming an adult and taking on the extra responsibilities. Having to meet people and develop new friendships can also be frightening. They may fear they will not be accepted or fit in. Some may not even want to be in college. They may have been pressured into going there by their parents. All though college can be a wonderful experience for people, for some, it can be one of the worst.

It takes time for people to adjust to college life. They leave behind the things that are most familiar to them. Their families, friends, home, their own room and many other things that may have helped them to feel secure. All of a sudden they enter into a world full of new responsibilities, new people and it can be a very frightening, confusing and lonely time. Many start to feel all the pressures from the minute they arrive. They have a full course load, many late night study sessions, and the stress of assignments that are due, in addition to exams. Some may also have to hold down part time jobs to make ends meet. They may not be used to the added responsibilities of being independent like having to do their own laundry, go shopping and cook for themselves. On top of all that, they may also worry about being accepted by their peers. All this together can be very stressful and we are seeing many college students turning to eating disorders as a way to cope.

When the pressures get to be too much, some may turn to anorexia as a way to block out what is happening. If they spend all their time focusing on calories and their weight, they don't have time to think about anything else. Others might believe that the only way they will be accepted, is if they are thin. If someone is having trouble in

their courses and not getting the marks they wanted or expected to, they might also develop anorexia. As the scale goes down they start to believe that losing weight is the one thing they can succeed at and it makes them feel like they are accomplishing something. Others may turn to bulimia or compulsive eating as a way to deal with the pressures and all the emotions that they are experiencing. If they are feeling lonely, sad, tired, overwhelmed, depressed, scared, or confused, food can bring them a false sense of security and can also comfort them. When they binge, all the negative feelings they are experiencing disappear. When the bulimics purge, whether that be by vomiting or compulsively exercising, it may help them to feel like they are releasing all those feelings. Since food can only temporarily help deal with the negative feelings, the binge/purge cycle will continue.

Date rape on campus is also on the rise. Many people that develop an eating disorder are victims of sexual abuse and sexual assault. If they are too afraid to report the rape or feel too ashamed to admit what has happened, they may develop an eating disorder as a way to cope with the assault. It is very difficult for someone to come forward and report a rape that has happened on campus. They fear that they will not be believed or they will be made to feel responsible for the assault. Some colleges are now encouraging people to come forward and taking action against the people that commit the crime, but some still prefer to keep it quiet and will discourage the victim from pressing charges and talking about the assault. I do feel it is the responsibility of the colleges to make the campus a safe place for all their students. Many colleges now have students that volunteer to walk other students to their cars or dorms when they have late night classes. Others hire security guards to patrol the grounds. If any of these services are available to you, I would urge everyone to use them. If you don't have any of these services available to you, you may want to pass around petitions trying to get services like this at your college. Until they are available to you, it is best that you try to stick in groups. Never walk alone at night, especially in areas that are isolated.

Many people are not even aware that they have an eating disorder because eating disorder behaviors can be very accepted on college campuses. On some college

campuses we are starting to hear about groups of people taking part in what is called a "binge/purge" party. They gather together to talk, laugh and eat. They usually eat much of what they consider to be the "forbidden" foods and then they take turns using the bathroom to purge. It may sound hard to believe, but these kinds of things do happen. We even hear about people sharing diet pills, laxatives, and diuretics. It would be very difficult to realize you have a problem when so many people around you are doing the same thing. It is important that people do know that this is abnormal behavior, it can be very dangerous and they do need help.

For those that do realize they have an eating disorder, it can be very difficult for them to seek help. Many people with eating disorders tend to feel like they are crazy and that they are only person who does the things they do. They avoid telling someone for fear that they will be thrown out of college or placed in a mental institution. Health and counseling services at all colleges need to make students aware that they can go to these places for help. They should provide the students with information to help educate them. They should also provide psychological, medical, and nutritional counseling. Many colleges do provide some of these services, but there are still many that need to start, especially for the students that are from out of town and don't have families to turn to for help. It would also be helpful for colleges to provide stress management classes for their students. Since there are such a high number of college students suffering with eating disorders, it would be helpful for the students to have a support group to attend. Being with others that know and understand how they feel can help to show them that they are not alone. The more services that colleges provide for students suffering with eating disorders, the better their chances are for recovery and to learn to adjust and deal with all the pressures that go along with college life

3. Literature Review Many sociable and medical researchers have shown that Mass media were playing a great role, to dedicate a specific image for the skinny model in teens mind. Moreover, any girls whom dont have We are going to stand up whether if Mass Media caused Anorexia among Student. In united state there were a study which conduct by North

Carolina University and prove that Media is become the main cause of Anorexia as its dedicate the specific images in girls mind about their bodies "Research has identified a number of causes of eating disorders among young women, the most significant of these being societal/cultural pressures that value thinness over fitness (Walker). Nutritionist Mae Cleveland says, The media perpetuates and feeds into the strong feeling that women have to be thin (qtd. in Walker). In the U.S., women are inundated daily with advertising and media that purport the ideal beauty as thin (and white, will be discussed later) while simultaneously portraying fat as something undesirable and unattractive".

In other Research which conduct by Broveskin Medical center in Germany, said that " In recent years, a number of potentially modifiable risk factors for EDs have been identified. Across populations and in longitudinal studies, excessive weight and shape concerns have been consistently associated with the onset of subclinical and clinical level EDs.4- 5 Given their importance as a risk factor, many investigators have attempted to reduce weight and shape concerns.13 We have shown that Student Bodies, an Internet-based cognitive-behavioral intervention, is effective in reducing weight and shape concerns."

4. Methodology

A total of 500 person participate in this research as a sample, female adolescents aged 18- 25 years with were recruited from the prince Mohammed University. We included female students with normal behaviors and others whom suffering from doing diets for all of their life and others whom suffering from Anorexia. We contributing survey through emails, printed out, and oral questionnaire. We looking after many other resarchs in the same fields and got the main information about Aneroxia.

We met doctors in that field to collect information which belongs to this research, and become beneficial for our thoughts. 5. Findings College-age women were recruited via e-mails, posters, and mass media. Six hundred thirty-seven eligible participants were identified, of whom 157 were excluded, for a total sample of 480. Recruitment occurred between November 13, 2012, and October 10, 2012. 100% of samples are student girls, 60% between age 19-21, 30% between age 2225, and 10% between age 16-18. 90% of them are student and 5% working, and other 5% is staying home. 75% are single and 25% are married. 7% of the sample has size (6-8), and 13% above 22 sizes, while the wide range of has the size 14-16 with 66%, 23% of the sample is between (18-20), and 11 above size 22.

There is 2% of the sample their weight Less than 40, 9% their weight 40-45, 8% their weight between 49 to 51, 20% between (52-62), 20% between (63-73), 15% between 96 to 106 kg, and 5% Above the 107. There is 55% of the sample follow diet program all their whole life, and 10% follow a program diet every 6 months.

6. Discussion What is Anorexia means? Is it a respond for our fashionable desire or respond for real desire to become healthy? How fashion barands influence the perfect image of being thin and skinny? How the media helps in dedicate the image of thin model in females mind? Whey anorexia is something we should fear?

Why it is important to aware about this disease? What is a definition of Anorexia Nervosa? What does the term Anorexia Nervosa define? Who is at risk for developing Anorexia Nervosa HOW common is Anorexia Nerovsa IS there a certain type of teenager who develops Anorxia Nervosa? Are Anorexia teens typically rebellious and defiant? Why would someone starve herself? What are some of the psychological characteristic of Anorexia of Nervosa What is the physical complication of Aneroxia? Can Anorexia nervosa be fetal?

7. Validity To insure our thought, we hired numbers of medical sources in terms of reading and documentation. After we got our results and findings we compared their numbers and conclusions with our documents and findings we reach. 8. Recommendation for future research Evaluate statistical approaches for qualitative and quantitative methods including: (1) further development of procedures for describing ED for quantitative methods; (2) further development of recommendations for use methods that generalize the issue. (2) investigation themselves. discussions is encouraged. (3) and probit analyses will be undertaken. It is important to determine what issues are important for an appropriate statistical method 9. conclusion You cant be too thin or too rich. This modern somewhat cynical proverb says a lot about our culture. It is an attitude that sells millions of magazines and diet books, sends many people to diet doctors and diet programs and puts thousands of people on exercise regimenswhatever is necessary to get or stay thin.

This attitude is evident in our cultures choice of role models and heroes, many of whom are featured diet stories in popular magazines. Slim-Diet, and more. Very slim people model clothing. Magazines describe fashion models and their eating habits some models subsisting on a salad a day and lots of ice cubes to keep their pencil-thin figures. Our culture says, Thin is beautiful. Thin is smart. Thin is in. Be thin. Thousands of impressionable young people mostly young women decide to do just that. They diet and exercise to attain this ideally thin body. Generally, they stay within reason, but not always.Usually, the brightest and most agreeable children are the ones who decide not just to be thin but also to be the best at being thin, and it becomes an obsession, a disease known as Anorexia Nervosa. An Anorexic stops seeing her own body objectively. She usually she because 90% to 95% of anorexics are female sees only a fat, imperfect self even in the face of the near-skeleton that stares back at her from the mirror. Fat is bad. She will not be bad. This fierce dedication to starvation is, to the victim, the height of virtue. To the parents, siblings, teachers, school counselors and friends, it is terrifying. They see the child or young woman so obsessed that she rarely eats. She vigorously exercises for hours. She agonizes over eating small amounts of food. She looks gaunt and The magazines at the supermarket checkout counter inform about The Celebrity-Eat-Everything-and Stay-

emaciated. Family members are right to be concerned. This disease and disease it is can be fatal if not arrested in time, which is the purpose of this publication. We write it in the hope that parents, families, friends, school officials and teachers will learn the signs of anorexia and guide its victims to arrest it in time. We hope that, with the facts, you will be able to ignore the false reassurances of people with anorexia Everything is under control. Since anorexia can lead to serious complications, even death, the lives of many young people can depend on this knowledge and understanding.

The good news is that early detection and treatment usually achieve a full recovery, though it may take some time for the person with anorexia complete recovery, physically and psychologically. 10. Bibliography "Anorexia." Encyclopdia Britannica. Encyclopdia Britannica Online Academic Edition. Encyclopdia Britannica Inc., 2012. Web. 02 Apr. 2012. The article offers a definition of anorexia. It also provides information about the causes and possible consequences of the disease. So, this article helps me directly with the background information of my research paper. "BRAZIL: Model Dies Of Anorexia." Off Our Backs 36.4 (2006): 6.Academic Search Complete, n.d., Web. 2 Apr. 2012. The article describes how fashion industry influences the ideals of beauty even in such a country as Brazil. Traditionally, extreme thinness has never been an ideal of woman beauty there. However, the number of deaths caused by anorexia greatly increased. The article reports on the death of four women, one model and another fashion student due to anorexia. To name one, Ana Carolina Reston, a model who weighs 80 pounds died after collapsing at a fashion shoot. I will use these examples to support my claim and to make the research paper more credible for my audience. "Doctors Blame Unhealthy Body Goals for Many Eating Disorders." New York Amsterdam News 10 Apr. 2008: 31+. Academic Search Complete, n.d., Web. 2 Apr. 2012. The article reports on the charge of Medical Society of the state of New York against fashion industry for imposing unrealistic ideals of beauty on people. According to this research, cited by the Academy for Eating Disorders, extreme thinness of fashion models has a negative effect on selfesteem, leading millions of girls all over the world to such eating disorders as anorexia and bulimia.

"High Fashion and Eating Disorders." Feminine Beauty. Ed. Erik Holland. n.p., 29 Mar. 2012. Web. 2 Apr. 2012. This source states that the main reason for such eating disorders as anorexia and bulimia, is mental disturbance. Mainly, women try to achieve high-fashion models thinness because they choose them as the standard of perfection. They think they would succeed in life if they become perfect in some way. However, the responsibility rests not with thin models but with those who select them, fashion designers. After all, homosexual fashion designers dominate the whole industry. The article explains why they choose skinny models as the ideal of beauty and how it influences minds of people. Savukoski, Marika, Kaarina Mtt, and Satu Uusiautti. "The Other Side Of WellBeing What Makes A Young Woman Become An

Anorectic?." International Journal Of Psychological Studies 3.2 (2011): 7686. Academic Search Complete. Web. 2 Apr. 2012. The research reveals those factors that make a woman become anorectic. The causes of anorexia were collected from the narratives of 11 Finnish women who managed to survive and overcame their illnesses. Anorexia is a serious psyhiatric condition that can lead to death at its worst. The causes of anorexia have not been clearly defined, but the article tries to reveal the reasons and factors that make girls destroy themselves by anorexia. Shuriquie, N. "Eating Disorders: a Transcultural Perspective." Eastern Mediterranean Health Journal 5.2 (1999): 354-60. Web. 29 Mar. 2012 According to this article, as the ideals of beauty vary in different cultures, some girls are torn between traditional and long-established standards of beauty and new skinny beauty promoted by fashion industry. Teenagers from many different countries are taken as an example. Smith, Rebecca. "Fashion Industry 'Fuelling the Rise in Eating Disorders'." The Telegraph. Ed. Richard Fletcher. Telegraph Media Group, 1 Apr. 2007. Web. 2 Apr. 2012.

Smith points out that the constant bormadment of teenage girls with images of size-zero models puts their health at risk, fuelling the rise of eating disorders. The growing obsession with being ultra-thin is caused by dangerous influence of such cat walk stars as Kate Moss and Lily Cole on public. Thompson, Colleen. "Society and Eating Disorders." Eating Disorders Mirror Mirror. Ed. Colleen Thompson. EDSA Canada Mirror Mirror, 13 Sept. 2011. Web. 2 Apr. 2012. In this article, Thompson tries to is to persuade young teenagers, that the ideal thinness of high-fashion models is the result of starvation. It is an unnatural beauty which is not worth of trying to acheive it. Thomsen, Steven R., J. Kelly McCoy, and Marleen Williams. "Internalizing The Impossible: Anorexic Outpatients' Experiences With Women's Beauty And Fashion Magazines." Eating Disorders 9.1 (2001): 49-64. Academic Search Complete. Web. 2 Apr. 2012. Thomsens research is based on the interviews with 28 patients at an eating disorder treatment facility in the western United States. The authors analysis provides a detailed description drawn from the patients personal accounts of how fashion magazines have influenced their lives and eatingdisordered behaviors. Townsend, Catherine. Eating disorders aren't the fault of the fashion industry.

The Independent. 17 Sept. 2007. Web. 2 Apr. 2012.

The author of this article tries to persuade the reader that eating disorders are not the fault of fashion disorders. She also suffered from anorexia but she has never blamed fashion magazines or thin models for it. I will use this source for the opposing paragraph in my research paper.

What are Eating disorders?

Eating disorders are most successfully treated when diagnosed early but are not that easy to diagnose early. Teenagers with eating disorders tend to deny they have a problem when confronted by family, friends, and school professionals or by a physicians diagnosis. Many anorexics do not receive medical and/or psychological care until they are dangerously thin and malnourished. Bulimic teens can hide their symptoms because they usually have a normal body weight, thereby delaying help until they reach 30 to 40 years of age. For males with eating disorders, early access to treatment is more difficult because anorexia and bulimia are less common; but there is a suggestion that the prevalence of these syndromes in males is increasing. Teens often conceal their symptoms, thus interviews with family members should be part of the assessment. Several other factors complicate the chances of early diagnosis, which include the distrust that teens have of adults and authority figures, a need for

privacy, not talking due to fear of revealing vulnerabilities, and fear of parental involvement and punishment. Important Notes: There is a diagnostic criterion for eating disorders called not otherwise specified (or NOS), which excludes anorexia nervosa, bulimia, or binge eating. NOS is not covered in this article. Obesity is also an approved medical diagnosis but is not an eating disorder diagnosis.

Anorexia Nervosa Anorexia nervosa dates back to the Middle Ages where it was contemplated whether self-starvation was the work of the devil or God. In 1649 Richard Morton, an English physician gave the illness a place in the medical archives. Dr. Morton described anorexia as "nervous consumption", a complication of a disease such as diabetes or tuberculosis rather than a separate illness. In the early 1870's, a British physician, Sir William Gull, described anorexia nervosa as a separate disease. Sir Gull named anorexia nervosa nervous loss of appetite. He believed anorexia was caused by a sick mind; however, many of his patients were wealthy and were rarely sent to a mental institution. Anorexia and other related eating disorders are now classified as illnesses and have a place of their own in the Diagnostic and Statistical Manual of Mental Disorders Sir Gull was correct. Based on available statistical information this is what we generally know about the prevalence of anorexia: Anorexia nervosa is one of the most common psychiatric diagnoses in young women. Between 1% and 2% of American women suffer from anorexia nervosa Approximately 90% to 95% of anorexia nervosa sufferers are girls and women. Anorexia nervosa typically appears in early to mid-adolescence. It has one of the highest death rates of any mental health condition. Between 5% and 20% of individuals struggling with anorexia nervosa will die. The probability of death increases within that range depending on the duration of the illness.

Diagnostic Criteria for Anorexia Nervosa

All of the following are required in order to make a diagnosis of anorexia nervosa. Underweight defined as less than 85% of ideal body weight Loss of menstrual periods or menses (in females) menstruation may occur only following hormone administration Extreme fear of gaining weight or becoming fat even though underweight Distorted body image or undue influence of body weight or shape on selfevaluation Denial of the seriousness of current low body weight

Differential Diagnosis for Anorexia Nervosa The following must be ruled out in order to make a diagnosis of anorexia nervosa: 1. Weight loss associated with a medical condition and the characteristic features of anorexia such as distortion of body image or an intense fear of getting fat are not evident. 2. 3. Bulimia Nervosa the low weight characteristic of anorexia is not evident. Weight loss in depressive disorders intense fear of getting fat seen with anorexia is not evident. In addition, symptoms of depression and a loss of interest are present in depressive disorders. 4. Schizophrenia low weight and intense fear of getting fat not evident. In addition, delusions, hallucinations, and/or disorganized speech are usually present in schizophrenia. 5. Food obsessions or compulsions in Obsessive-Compulsive Disorder low weight and intense fear of getting fat not evident. Obsessions and

compulsions are not restricted to thoughts or behavior about food or weight. 6. Social Phobia (avoidance of eating in public) low weight and intense fear of getting fat not evident.

Bulimia The Romans engaged in a type of bulimia referred to as ox hunger and had vomitoriums where men would vomit so they could continue to eat, drink, and be merry. Medical doctors and psychiatrists knew little about bulimia before the 1970s.

A pattern of binge eating and purging was first linked to the advanced stages of anorexia. In 1979, Dr. Gerald Russell was the first to name the disorder Bulimia Nervosa. He described a bulimic patient by noting the patient suffers from powerful and intractable urges to overeat; the patient seeks to avoid the fattening effects of food by inducing vomiting or abusing purgatives or both; the patient has a morbid fear of becoming obese. Based on available statistical information this is what we generally know about the prevalence of bulimia: bulimia nervosa affects 1% to 3% of middle and high school girls. Approximately 80% of bulimia nervosa patients are female. People struggling with bulimia nervosa will often appear to be of average body weight.

Diagnostic Criteria of Bulimia All of the following are required for a diagnosis of bulimia nervosa. Regular (at least twice weekly) episodes of binge-eating characterized by: eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances. A sense of loss of control over eating during these episodes (e.g., a feeling that one cannot stop eating or control what or how much one is eating) Regular (at least twice weekly) inappropriate compensatory behavior such as self-induced vomiting, laxative or diuretic abuse, fasting, or excessive exercise. The binge eating and compensatory behavior occur twice a week for three months. Undue influence of body weight or shape on self-evaluation There are two types of bulimia, the purging type and the non -purging type. The purging type engages in self-induced vomiting or misuse of laxatives or diuretics. The non-purging type uses other inappropriate compensatory behaviors such as fasting or excessive exercise, but does not regularly engage in self-induced vomiting or misuse of laxatives or diuretics.

Differential Diagnosis for Bulimia

The following must be ruled out in order to make a diagnosis of bulimia nervosa: 1. Vomiting or diarrhea caused by a general medical condition or by excessive substance abuse 2. 3. 4. 5. 6. Binge eating in anorexia nervosa Overeating in depressive disorders Binge eating in Borderline Personality Disorder or Schizophrenia Binge eating in Binge Eating/Compulsive Overeating disorder Eating disorder Not Other Otherwise Specified

Binge Eating/Compulsive Overeating The eating disorder of binge eating is relatively new; therefore, the medical complications, causes, as well as the prevalence are still being studied. Binge eating disorder is also referred to as compulsive overeating. It is characterized by periods of uncontrolled, impulsive, or continuous eating beyond the point of feeling comfortably full. Erratic fasts or repetitive diets may occur but without purging and are followed with feelings of shame or self-hatred. Compulsive overeaters often struggle with anxiety, depression, and loneliness.

Binge Eating Statistics Available research indicates the following statistics: Approximately 25% of obese individuals suffer from binge eating. About 60% of individuals with binge eating are females. Body weight varies from normal to severe obesity.

Diagnostic Criteria of Binge Eating 1. Recurrent episodes of binge eating. characterized by both of the following: Eating in a discrete period of time (e.g., within any 2-hour period) an amount of food that is definitely larger than most people would eat during a similar period of time under similar circumstances. 2. A sense of lack of control regarding eating during the episode. The binge-eating episodes are associated with three or more of the following: An episode of binge eating is

 3. 4. 5.

Eating more rapidly than normal. Eating until uncomfortably full. Eating large amounts of food when not physically hungry. Eating alone out of embarrassment by how much one is eating. Feeling disgusted with oneself, depressed, or guilty after overeating. Marked distress regarding binge eating is present. The binge eating on average occurs at least 2 days a week for 6 months. The binge eating is not associated with the regular use of inappropriate compensatory behaviors.

Medical Complications of Eating Disorders Teens with eating disorders place themselves at risk for anxiety disorders, depression, cardiovascular compromise, chronic fatigue, chronic pain, depression, infectious diseases, insomnia, neurological symptoms, as well as suicide. During selfstarvation, as seen in anorexia nervosa, the body is denied the essential nutrients needed to function properly, forcing body systems to slow down in order to conserve energy. This defense mechanism has serious health/medical ramifications. Recurrent binge-and-purge cycles can impact the entire digestive system and lead to electrolyte and chemical imbalances in the body, which can affect the function of the heart and other vital organs. Whats more disturbing, is that even with successful treatment, complications may extend into adulthood such as infertility and poorer health. The chart below identifies many of the complications that can occur with an eating disorder, and although it is extensive, it is not meant to imply an all-inclusive list.

Anorexia Nervosa Medical Complications 1. Cardiac abnormalities and heart failure 2. Dangerously low blood pressure 3. Dangerously low body temperature 4. Growth of lanugo, hair loss, dry hair and nail destruction 5. Low white blood cell count 6. Chronic constipation 7. Osteoporosis due to estrogen loss

Bulimia Medical Complications 1. Electrolyte imbalances can lead to

irregular heartbeats, Electrolyte heart failure is or death. by

imbalance

caused

dehydration and loss of potassium and sodium from purging. 2. Dangerously low blood pressure 3. Abnormal menstrual cycles

8.

Loss of menstrual periods and or 4. Enlarged parotid glands (salivary gland) 5. Gastric rupture during bingeing

infertility 9.

Muscle wasting, fainting, fatigue, and 6. Inflammation or rupture of the esophagus weakness 7. acids released during vomiting albicans infections (yeast 8. Chronic irregular bowel movements and constipation 9. Peptic ulcers and pancreatitis 10. Dry skin and acne breakouts 11. Candida albicans infections 12. Food allergies Tooth decay and staining from gastric

10. Severe dehydration can result in kidney failure 11. Candida

infection) 12. Hypoglycemia.

Binge Eating Medical Complications 1. High blood pressure 2. High cholesterol levels 3. Heart disease due to elevated triglyceride levels 4. Diabetes 5. Gall bladder disease

Assessments of Eating Disorders A multi-disciplinary approach, which includes a medical history and physical, a nutritional assessment, and a psychological assessment, is necessary for the evaluation of eating disorders. Most treatment centers, hospitals, and professionals use standardized assessment tools based on their preferences such as the ones listed below: The Eating Attitudes Test (EAT-26) measures the severity of anorexic symptoms The Bulimia Test Revised (BULIT-R) measures the severity of bulimic symptoms The Beck Depression Inventory (BDI) measures the severity of depressive symptoms Laboratory testing is also an essential component of the evaluation. Teens with eating disorders may have normal values; however, abnormal values provide supporting

evidence or can point to medical complications rather than an eating disorder. Routine laboratory and diagnostic tests are as follows: Amylase if elevated may indicate possible regular episodes of vomiting Bone density testing evidence of bone loss suggesting mineral deficiencies or ammenorrhea Cholesterol if elevated may indicate possible compulsive overeating EKG or Echocardiogram abnormal rhythms or cardiac function Magnesium if decreased may indicate possible laxative abuse Potassium and sodium if decreased may indicate possible malnutrition, purging, and/or excessive fluid intake Urine ketones if elevated may indicate possible chronic fasting or decreased dietary intake Urine specific gravity if elevated indicates possible dehydration or excessive lack of fluid intake

Treatment I have always been curious about the use of the word treatment in medicine. There are beauty treatments, hair treatments, water treatments, lawn treatments, and even window treatments all indicative of action or management aimed at achieving a desired effect. Interesting enough, none of these achieve an everlasting result. There is no single treatment for an eating disorder. Treatment, just as assessment, requires a multi-disciplinary approach due to the complexity of emotional, physiological, and medical problems. Eating disorders have a profound effect on the homeostasis of body function and this balance needs to be restored. It is difficult to treat a teen psychologically and pharmacologically when their body is not in a condition to listen or concentrate because of malnourishment. Anorexics in need of a stable weight may have to consume more calories than someone of similar weight and age (who does not have an eating disorder), and consuming calories is exactly what anorexics do not want to do. Some anorexics can guess their blind weight just by the sound of the scale. Even normal weight bulimics are vulnerable to weight gain when they consume the required calories. The care/treatment team should consist of:

1.

A medical physician or nurse practitioner to conduct a physical assessment, laboratory and diagnostic testing, and alcohol and drug screening;

2. 3.

A nutritionist to assess and advise on nutrition and eating regimens A psychotherapist or psychiatrist for immediate and long-term treatment. Psychological counseling must address the eating disorder symptoms AND the underlying psychological, interpersonal, and cultural factors contributing to the eating disorder.

4.

Group and family psychotherapist, Cognitive-behavioral therapy to provide teens with ways to reframe the existing habit (abnormal thoughts and behavior) this is often one of the most productive forms of treatment because the therapists focus is on changing eating behaviors by rewarding or modeling wanted behavior. Group therapy has been effective for individuals with bulimia. Caution must be used when sharing anorexic success stories as they can sometimes be destructive to treatment (by inducing a feeling of failure for those who are still struggling). The value of including siblings needs careful evaluation prior to implementation. Excluded siblings may think they are part of the problem; whereas over-bearing /over-protective siblings may be counter-productive.

5.

A psychopharmacologist to impart expertise about psychoactive medications used to treat eating disorders. Antidepressant medications commonly used to treat bulimia include desipramine and imipramine. Fluoxetine has been useful in treating some patients with binge eating disorder as well as any co-occurring depression.

Once a diagnosis of an eating disorder is confirmed the best course of treatment must be developed. If the teen is medically unstable hospitalization is indicated. Criteria for hospitalization include: Excessive and rapid weight loss (weight less than 75% of ideal body weight); Serious metabolic disturbances often evident by heart rate less than 45 BPM, change in pulse or systolic blood pressure, or potassium or phosphorus less than 3.0; Clinical depression, risk of suicide, or psychosis; or Severe binge eating and purging.

Medically stable teens can be treated without hospitalization on an outpatient basis. Teens may elect residential care in an eating disorder center that includes individual, group, and family therapy, along with medical management. Once discharged from an inpatient setting, follow-up is necessary in order to continue to treat underlying issues associated with the eating disorder. Treatment should also aim at relapse prevention. Cognitive distortions such as denial and rationalization, which occur in eating disorders, make it easier for the teen to set up a relapse episode. These teens need to have new coping skills and be able to implement lifestyle modifications. There is insufficient research regarding the continuities and discontinuities of eating disorders across a persons life span. This is what we know from short-term outcome data collection: Anorexia nervosa has the most severe consequences, with a mortality rate of 0.56% (or about 1 in 180) per year a rate that is higher than that of almost all other mental disorders. Approximately 20% of anorexics will not survive. Fatality is most often due to starvation, suicide, or electrolyte imbalance. The mortality rate from

anorexia nervosa is 12 times higher than that for other young women in the population. Many quit treatment, and as many as half will have relapses. The severity of the eating disorder as well as body weight are believed to influence the outcome. With treatment, about 50% of those with anorexia or bulimia will have a full recovery, 30% will have a partial recovery, and 20% will have no substantial improvement. The effectiveness of combining psychotherapy and medications continues to be studied by scientists associated with the National Institute of Mental Health. Some of their recent findings showed that group therapy and antidepressant medications combined or alone, benefited patients. For bulimics, the combined use of cognitivebehavioral therapy and antidepressant medication is believed to be the most beneficial. Combination treatment was effective in preventing relapse once

medications were discontinued. The long-term effect of eating disorders on teens and the efficacy of treatments are unknown. What is time-honored is that we must care for and treat the teen and the underlying pathology that is unique for each of them. Collectively, our

responsibility is to continue to learn more about these disorders and create a synergy between the diverse clinical management team.

The Impact of the fashion industry in promoting the extremely thin feminine ideal

Fashion did not suddenly begin to promote an anorexic-like slenderness of the female form in the 1990s, rather the move towards such an extreme has evolved during the

twentieth century, with Naomi Wolf and Susan Brownmiller referring to this reduction of the flesh as a twentieth century phenomenon. To poster any new ideas, an understanding of what has gone before is necessary, and the following is an outline of the way that fashion design has contributed to the evolution of the extremely slender feminine ideal of Contemporary western society. Such an analysis highlights the parallel between fashion and body ideals and shows that fashion does not simply dictate feminine ideals, but is a reflection of society. The modern movement toward this slender silhouette in the western world appeared in the 1920s, with Flapper dresses which demanded a flat boyish figure to do them justice. Although such an ideal is theorised to have been reaction to World War One, fashion played a large part in its promotion, with garments designed specifically for such a figure. The 1920s employed girdles and breast flatteners to achieve such an ideal. It was only ten years later that the duchess of Windsor said the much quoted; you cannot be too rich or too thin. There was a short-lived revival of feminine curves in the 1960s in the shape of Marilyn Munroe, wearing a size 16 dress in Some Like it Hot. But hips and breasts soon disappeared again with the emergence of the size six Twiggy becoming the body type of mature womens desire only five years later.

The new thin ideal represented a departure from the use of undergarments, and a move toward personal control of body image through dieting. The gaunt, prepubescent image of Twiggy may well have signalled the move from the svelte body to the emaciated body. Twiggy epitomised the freedom and ideals of the youth revolution that was the jet set. The advent of the bikini in the 1960s also promoted the new thin silhouette, as Susan Brownmiller states: Of all the changes that revolutionised the female body of the 1960s, the French bikini deserves special credit". Brownmiller also attributes the advent of artificial fibers in the sixties as defining a new direction for the body. Saint Laurent and Pucci designed jersey garments that did not allow for substantial undergarments, calling for more attention to the body underneath.

Shelly Bovey, Susan Bordo, Sharlene Hesse-Biber and Susan Brownmiller also propose that the move towards extreme thinness began in Britain and America in the 1960s, but they parallel this change in ideals to the beginning and rise of the feminist movement. Hesse-Biber states that Just as women were demanding more space and more equality, the cultures standards of attractiveness demand that they shrink. These feminists did not see the shrinking female form in the face of greater liberation as a coincidence, with Kim Chernin seeing it as a conspiracy, stating that There is a relationship between the standards set for womens beauty and the desire to limit their development. Whether such standards are regarded as being set by men becomes unclear, but by escaping these idealisations it was thought woman could achieve equality, freedom of mind and become all-powerful.

The 1980s signalled a new importance on the body as we know it. Fashions changed, becoming more reliant on the figure beneath. Exercise and body sculpting became popular and The body itself, rather than its clothing, became the significant means of communication, and this meant greater demands were made of the bodys aesthetics. Such a toned and taunt body relied on no shaping undergarments, but became the undergarment, or supporting structure upon which the clothes became a type of decoration. The development of lycra and body hugging fashions such as leggings put the body in the spotlight more than ever, turning the body into an outer shell. These clingier fashions, Brownmiller notes, forced the average woman to assume direct responsibility for the shape of her body. Not since the twenties has a womans figure been expected to stand on its own without a foundation garment.This change to shaping the body from the inside is explored by Sharlene Hesse-Biber, when she states: The shift from external to internal control was part of the ideology of womens independence. The svelte ideal was taken to its extremity in the 1990s with the emergence of waif models, epitomised by Kate Moss and Jodie Kidd. Another development of this ideal in the late 1990s was heroin chick where extremely thin models were made up with makeup that made them appear to look ill. Such images promoted by the fashion industry have been directly blamed for the increasing incidence of eating disorders (namely anorexia nervosa) in the modern Western world.

In the 21st century the average fashion model weighs 25% less than the average Australian woman and the fashion and media ideal size is a ten, and often an eight. While society gets larger models and fashions ideal continues to shrink. As such fashions become discriminatory measures, serving to create divisions within society. The larger woman is confined to wearing dark sacksand is denied the chance to be part of the fashionable elite. Recently an article in Who Weekly (1996) acknowledges that renewed fashion trends, such as hipsters and clinging man-made fabrics, demand extremely thin models, and thin models will be required as long as these fashions are in vogue.

Fashion Media and Advertising

In a study of anorexia nervosa, by Hilde Bruch, she says that she: is inclined to relate [anorexia] to the enormous emphasis that fashion places on slimness Bruchs definition of fashion though is ambiguous. If we take fashion and society as being elements of one another, dependent on one another, then I would say that this statement rings true. Fashion is only one aspect of modern society that emphasises the slim ideal. Indeed, media imagery is rampant in contemporary Western society, with television, movies and print media rarely including the larger woman unless it is in a satirical manner. And so the modern woman comes to learn that she can only be loved and accepted when slender. At the same time though fashion media does play a significant role in dictating this thin ideal. And it is recognised that there are certain women in society who are more pathologically susceptible to media imagery and actively compare themselves to it. Fashion magazines have been found to have a negative impact on womens sense of body image. A study in Psychology Today, in 1997, found that after three minutes of looking at images of fashion models 70% of women felt guilty, depressed or ashamed. Catherine Steiner-Adair also identifies this correlation, conducting a study of adolescents that drew a definite relationship between food and body image disorders and the desire to conform to the beautiful, independent, cool superwoman of media imagery.

Not only do fashion magazines impact womens sense of body image, but th ey also send out confusing social messages as to what constitutes a woman in modern society. A study of fashion magazines between 1960 and 1980, conducted by Leslie Rabine, found a persistent contradiction in the images of femininity they displayed. Kim Chernin, also recognises this contradictory message; one of which is a movement toward feminine power, the other a retreat from it, supported by the fashion and diet industries, which share a fear of womens power. An image of a confident, sexually powerful, successful woman, who uses makeup, clothing, and body shaping techniques to enhance these attributes, is frequently juxtaposed with images of

feminine frailty; with articles on rape and salary inequalities and sexual harassment. Such a dualism can still be seen in fashion magazines today, where images of extremely thin models are opposite cookbooks and dinner party guides; telling women they should provide but not enjoy. Similarly there are articles about how to lose weight quickly next to articles on how to be confident and increase your self-esteem. It seems that the media industry is as confused about womens powers and rights in society as women are, but as to whether the media is reflecting this sentiment, or instigating it is a vicious circle of debate.

Indeed, it has been found that while most women aspire to emulate the aesthetic of models in magazines they recognise that these are unrealistic and unhealthy images of a feminine ideal. As such women cannot be seen as submissive victims of a system of oppression, and indeed, many groups and individuals are actively opposed to the extreme slenderness of females in the media. Although the media is very

discriminatory about the body size of the women it portrays, society is still able to interact and decipher these messages as they choose. Naomi Wolf makes an appropriate note that the fashion industry (in particular womens magazines) cannot become more interesting until women believe that we ourselves are more interesting. In other words, fashion only reflects the sentiments of society, and so the change has to start with society. In the mean time attempts by the fashion industry to show diversity of female form will be seen as freak shows and media grabbing attempts until society adopts a less discriminatory attitude toward body size. While this is true, fashion still has power within society and although fashions success in promoting a diverse image of feminine beauty ultimately depends on societys reaction to it the change can begin from both directions.

Marianne Thesander suggests that the fashion industry creates such unreal ideals of femininity to sell products; The fashion and beauty industries can always sell their products by fabricating new ideal images which also appeal to the more liberated woman, who rarely likes to admit that it is important to them to be attractive.(10) The idea that an unrealistic and unobtainable image of feminine beauty is necessary to sell fashion and beauty products is advocated by the marketers of such products, and

discussed by Naomi Wolf in her text, The Beauty Myth: The advertisers who make womens mass culture possible depend on making women feel bad enough about their faces and their bodies to spend more money on worthless or pain-inducing products than they would if they felt innately beautiful. Anita Roddicks Body Shop concept uses reverse psychology (which is actually common-sense psychology) to foster a positive store environment, proving that the beauty industry does not need to resort to intimidation tactics to be successful. It is possible to sell by promoting a positive sense of body image

Joanne Finkelstein, in her text, After a Fashion, discusses Leslie Rabines idea that donning clothing and conquering the biology of the body is part of the process of enacting the fantasies of fashion magazines upon the body. At the same time a sense of failure is incurred due to the inability of the lay person to replicate the artificial ideals of the fashion model. But Rabine argues that it is this failure that is the allure of fashion. Fashion succeeds because it is unachievable; The look is always beyond, out of reach, and hence it always seems attractive. Such an idea is also endorsed by Ted Polyhemus in his book, Body Styles, where he says the ideal body is, by definition, unattainable. This concept renders the possibility of producing diverse images of womens bodies unsuccessful, as they do not induce desire, due to their attainability. Marianne Thesander, in her text, The Feminine Ideal, says beauty must be untouchable, almost unachievable, stating; It is desirable to be slim because it is difficult and often demands time and money. If everyone had the same opportunity to stay slim, the ideal of slimness would be quickly replaced by another status ideal. And so it has been argued by many magazine editors that although women protest, they are equally averted to seeing realistic images of women, as the industry is based on fantasy, not reality and then it must be asked, is it futile to rally against fat oppression, when it will only be superseded by another, equally unobtainable ideal? And certainly when a diet pill emerges that does work this may prove to be the case. In the name of evolution though fat oppression must be eradicated " Hesse-Biber" says women will only free this oppression from slenderness if society begins to

acknowledge a broader view of the feminine that includes aspects of both mind and body.

Sizing Strategies
Roberta Seid, in her text Never Too Thin, notes that beauty was becoming democratized as ready-made clothing introduced the idea of standard sizes. Now such an idea by the fashion industry that people can be segmented into a limited range of categories was and is ridiculous. Previously clothing had been tailored to the individual. The advent of mass manufacturing and standardized sizing had a negative impact on womens sense of body image. Such sizing policies do not allow for differences within a size. A standard size meant that not only did you have to fit the critical bust, waist and hip measurements, but you also had to be the correct height and proportions.

American designer, Calvin Klein, made it explicitly clear that he would not tolerate the larger woman: I dont want women bigger than a size 12 wearing my clothes(2). And designers have the power to dictate this. Although anyone can purchase the clothing, they are often only produced in a limited range of sizes; usually eight to twelve(3). Such policies on the behalf of designers can have very negative effects on womens sense of body image and actually act as a catalyst for them to lose weight. This was epitomised by Barbara Quelch who after having her jaws wired, and her stomach stapled stated: I have always wanted to wear modern clothes and now I can go into a boutique and choose what I want rather than go for something just because it fits.(4)

The worrying statistic is that the tyranny of slenderness is infecting women at an increasingly early age. Sharlene Hesse-Biber quotes a twelve year old in her text Am I Thin Enough Yet? The Cult of Thinness and the Commercialisation of Identity as saying: When I see these twigs of people in the magazines and on TV, I say Im going to go on a diet. I think I wont look good in those clothes because Im not that thin. You almost want to get thin just so you can wear the right clothes. Darcey age 12 (5).

Jane Mulvagh, in her book The Vogue History of Twentieth Century Fashion states that well designed clothes today are sized to fit bodies that rely on coffee and cigarettes to maintain their artificially slim ideal. She states that such restrictions on what size a fashionable woman is allowed to be does not only influence models and adolescents, but that extreme thinness also infects middle-aged women who diet down to a size eight in order to struggle into clothes designed for a teenage body. (6)

The tyranny of the fashion designer occurs when s/he argues that it is not economical to accommodate the fluctuations of womens size and shape. He designs for a straight, flat chested girl because anyone with curves would only distort his intended silhouette. (7) Kim Chernin shows the ridiculousness of such an idea, outraged that the size statistics of the land are not reflected in fashion boutiques, which do not even cater for the average sized woman in America. For surely this would be economical?

Kim Chernin also questions the fashion industrys sizing strategy and boutique policies, giving a heartfelt description of a woman entering a boutique with the knowledge that she will not conform to the ideal the fashions demand. She calls the fashion boutique the showplace of our culture 'and points out how significant this trend is that fashion refuses to fit the larger woman. She points out that if large sized clothes are called womens sizes, then who are the garments hanging in the fashionable boutiques intended for For surely, you see that they were not intended for a woman? And Chernin recognizes that such failure to conform to fashions ideals has a strong impact on the non-conforming woman, making her question why fashion does not recognize maturity in a woman. According to fashion, large size, maturity, voluptuousness, massiveness, strength, and power are not permitted if we wish to conform to our cultures ideal. Our bodies, which have knowledge of life, must undo this fullness of knowing and make themselves look like the body of a precocious child if we wish to win the approval of our culture. Standardized sizes also become a measure against which women measure their bodies worth. Sharlene Hesse-Biber recognizes this trend in her interviews with women.

Clothing became an incentive to lose weight when too tight and a celebratory indicator when lose. The fear of outgrowing clothing in the wardrobe was also recognized as an incentive for staying the same size. Many of the women had an aversion to wearing larger sizes in garments, even if they fitted better, as a woman knows what the fashionable sizes are and wants to stay within that range.

This idea is further reinforced by Sarah Grogan who quotes interviews done by Penny Cortvriend, Lisa Bradley, Helen Richards and Debbie Mee-Perone between 19941996 concerning womens body dissatisfaction. They draw attention to the influence of the fashion industry on womens sense of body image: Fashion dictates really what size you are, because none of them go over a size fourteen anyway you couldnt be fat and fashionable and another I dont have an ideal weight. I just have to feel comfortable in my clothes.

The study done by The Body Image and

Better Health Program in Victoria

concerning women and their sense of body image identified the fashion industry and clothes shopping as major contributors to this deteriorating sense of self worth. Many of the women believed that fashionable clothing was designed only with a thin tall woman in mind, and was therefore discriminatory. Such discrimination by the fashion industry made these women regard such a body shape as enviable and superior over others and that fashion generates, perpetuates and depends on this slim idealization. The survey also recognized the experience of trying on clothing as a time when women were forced to analyze their bodies and their relation to the standardized sizes the fashion industry produces. Rather than seeing the clothing as the wrong size for their body, the majority of the women blamed their own body for not being the right size for the clothing, i.e. unable to conform to the standardized sizing; You think, If this is made for a normal woman, whats wrong with me? and It is the image. You see the image and you think Id like to wear that image so you go and try it on at the store and they dont fit, so you realize you dont fit into that image. The women studied also complained about the layout of clothing stores, the predominance of

mirrors, model like attendants, change room policies and the lack of availability of larger sizes. Fashion with its standardized sizes does not allow for diversity in form. And often larger sizes are produced by scaling up a size ten garment, which is not anatomically correct. Designers are also documented as manipulating sizes to discriminate further against larger sized women, with many high end fashion boutiques producing sizes that are smaller than the reality, i.e. a garment labelled a 10 is in reality an 8. That a size 14 which was once the largest normal size has suddenly become the smallest large size, distresses Kim Chernin, especially as the average size of a woman in Britain is a 14-16. Rather than beginning to cater for this woman, the fashion industry has re-positioned her into the large sector of the market place, so vilifying the majority of women. Not only do fashionable garments dictate the desirable body size for a woman, it also dictates the ideal proportions of her body. As Susan Brownmiller, in Femininity says: Clothes are never designed for low-slung pendulous breasts, dictating that perky, upright breasts are to be desired in Western society, when both the aged cannot conform to this ideal, and other societies, such as Papua New Guineans, admire the droopy breast. As The Harvard Medical School Health Letter states: For many being thin are a cosmetic rather than health goal which is fine for people who are naturally svelte. But human beings come in a variety of shapes and sizes. It is unreasonable to expect that everyone will conform to a single, ultra-thin standard. A lot of people (especially women) who are not by any reasonable definition overweight are subjected to discrimination and pressure to change their basic body type. This pressure should be resisted, difficult as it is to do so. Rather than trying to trim their bodies to fit this years fashions, many individuals should probably cut their clothing more appropriately to their figures.

11. REFERECES (1) Bovey, Shelly, The Forbidden Body: Why Being Fat is not a Sin, HarperCollins Publishers, London, 1994 ed. (2) Brownmiller, Susan, Femininity, Linden Press/ Simon & Schuster, New York, 1984 (3) Chernin, Kim, The Obsession: Reflections on the Tyranny of Slenderness, Harper & Row, New York, 1981 (4) American Psychiatric Association. Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1995. (5) Cohen MA. French Toast for Breakfast, Grze Books, 1995 (6) DSM-IV-TR Case Studies: A Clinical Guide to Differential Diagnosis, 1st ed., Allen J. J. Frances, Ruth Ross, American Psychiatric Press, Incorporated, September 2001. (7) Eating Disorders Review, November/December 2001. Vl. 12, Number 6

(8) Eating Disorders in Males, by Leslie Knowlton, Psychiatric Times, September 1995, Vol. XII, Issue 9 (9) Gidwani GP, and Rome ES. Gynecology, 1997;40:601-615. (10) Jantz GL. (1995) Hope, Help, & Healing for Eating Disorders, Shaw Eating Disorders. Clinical Obstetrics and

Publishing, a division of Random House, Inc. (11) Johnson JG, Cohen P, Stephanie K, Brook J. Eating Disorders During

Adolescence and the Risk for Physical and Mental Disorders During Early Adulthood. Arch Gen Psychiatry. 2002;59:545-552