“If I Could Just Lose Five More Pounds . . .”
Q&A with Dr. Andrea Vazzana, Clinical Co-director of NYU Langone’s
Eating Disorder Service
About 11 million Americans suffer from one of the two most common eating disorders:
anorexia (refusal to maintain minimally normal body weight and an intense fear of gaining
weight) and bulimia (recurrent binge eating followed by inappropriate compensatory
behaviors, such as self-induced vomiting). Most are adolescent girls, whom Andrea Vazzana,
PhD, clinical assistant professor of child and adolescent psychiatry and psychiatry, counsels at
the NYU Child Study Center as they grapple with intense self-scrutiny and potentially fatal
attitudes and impulses toward food. She recently shared her insights with news & views.
to refeed their child in spite of her protests. During the
second phase, the patient begins to resume responsibility
for eating, and weight is restored. Finally, when the teen
has reached a healthy, stable weight, lingering adolescent
issues and family dynamics are addressed. Within that,
therapy can look at issues that may have sparked the
onset of the disorder, including the patient’s core beliefs
that underlie the disorder—for example, that everything
would be perfect if she could just lose five more pounds.
What drew you to this specialty?
My college roommate struggled with bulimia at the same
time that I was taking a class in abnormal psychology. I
wanted to learn more about the disorder so that I could
better understand what she was going through. As a
woman, eating disorders were also something I could
relate to in terms of the pressure in our society to be thin.
What can parents do to prevent their children from
developing an eating disorder?
It’s important for parents to intervene early because the
longer the illness lasts, the more entrenched it becomes.
Eating disorders usually begin with dieting. Parents
should discourage their children from dieting and
promote having a healthy body that has enough energy
to do the things they love doing. Parents should also
monitor their own unhealthy eating patterns and critical comments they make about their bodies.
Dr. Andrea Vazzana stands next to a figure whose outer lines, drawn in black by one of her patients, show how the young woman
perceives her body. The inner lines, drawn in purple by Dr. Vazzana, reflect the actual outline of her patient’s body. Dr. Vazzana uses
this exercise to correct patients’ distorted perceptions of their shape and weight, which are common features of eating disorders.
What are common misconceptions about eating disorders?
It’s important to separate the person from the illness.
More and more, research is showing that there’s a genetic component to these disorders. So it’s much more
complicated than someone saying to herself, “I want to
be really skinny, so I’m going to stop eating.”
Are eating disorders primarily an American phenomenon?
Western countries have similar rates of these disorders.
Eating disorders are less common in non-Western
countries, but they are becoming more prevalent with
increased globalization and exposure to Western media.
Eating disorders have been on the rise for decades,
and so has obesity. Are the two related?
The disparity between our culture’s beauty ideal,
which favors thinness, and the abundance of food
available to us sends mixed messages that can lead to
unhealthy eating patterns.
How and when do eating disorders tend to develop?
It’s rare for eating disorders to begin prior to
puberty. Bulimia usually begins in late adolescence
and early adulthood. The average age of onset for
anorexia is a bit earlier, at age 17, with peaks at ages
14 and 18. If you think about what’s happening at
those two ages, it coincides with the beginning of
high school and college. The onset of the disorder is
often associated with these kinds of transitions, or
some other stressful event.
Are there personality differences between people with
anorexia and those with bulimia?
People who develop bulimia tend to be more outgoing,
emotionally reactive, and impulsive, whereas people with
anorexia tend to be socially and emotionally restrained,
risk avoidant, and perfectionistic. Anorexia has a 5 to
10% mortality rate. It’s the deadliest of all psychiatric disorders. Among patients who survive, about half regain
most or all of their weight, 30% show some improvement
with periodic relapses, and 20% have a chronic course.
What treatments are available?
Bulimia is usually treated with a combination of antidepressants and about a five-month course of cognitive-behavioral therapy (CBT). Anorexia is treated with
CBT, interpersonal therapy, or with teens, the Maudsley
Method, which is a family-based therapy. The first phase
of the Maudsley Method focuses on coaching parents
When someone with an eating disorder looks in the mirror, what does she typically see?
It’s likely that she hyperfocuses on what she considers
to be relative imperfections. I remember one patient
who was disgusted by the way the skin under her arms
jiggled. The problem was that she’d lost so much weight
that she had loose skin. But to her, it was: “I’m too fat.
Look at all this skin here—it’s gross.” Like other people
with eating disorders, this patient then judged her self-worth primarily on her body shape and weight, rather
than her other attributes. One of our main treatment
goals is to challenge such beliefs. Eventually, patients
are able to catch and counter their irrational thoughts
on their own.
For more information or to make an appointment, please call
Web Extra: for an article about an art exhibit, recently
mounted on N YU Langone’s campus, that portrays eating
disorders in all their complexity, see “Now You See Her—
Now You Don’t” at http://newsandviews.med.nyu.edu/.
Gratitude of the Greatest Magnitude (continued from page 1)
Empowered by these gifts, the Medical Center
has undertaken a dramatic transformation of its
campus infrastructure, the most ambitious in its history. This includes the construction of a new Center
for Emergency Services, four new patient elevators,
the Smilow Comprehensive Prostate Cancer Center,
the Yung Hsia Women’s Pavilion, and a new Critical
Care Unit—all in our flagship clinical facility, NYU
Langone’s Tisch Hospital—and major renovations at
the Elly Hammerman Inpatient Pediatric Unit at N YU
Langone’s Hospital for Joint Diseases. In addition,
support from our patrons has made possible the planning and design of the Helen L. and Martin S. Kimmel
Pavilion, scheduled to break ground in 2013.
Philanthropy has also allowed for the purchase
and renovation of two residence halls, including the Jan
and Marica Vilcek Hall on East 26th Street (named for
Jan Vilcek, MD, PhD, professor of microbiology, and his
wife, Marica, who have donated more than $125 million to N YU Langone), and scholarships for students
at N YU School of Medicine. In addition, donations
are responsible for the creation of a new neuroscience
institute (a gift from Fiona and Stanley Druckenmiller),
new science building, and the recruitment of more
than 50 distinguished faculty members, as well as the
establishment of 33 new endowed professorships.
“From the beginning, Board Chair Ken
Langone’s second leadership gift and Dean and CEO
Bob Grossman’s ambitious vision, agenda, and clear
plan for our leading academic medical center have
resonated with our community’s inherent generos-
ity and extraordinary loyalty, inspiring our donors to
invest with us as true partners,” says Lisa Silverman,
vice president for development and alumni affairs.
page 4 | news & views