There isn't one single cause of drug addiction. This is one of the reasons drug addiction is very hard to treat. Years ago the term “addictive personality” became very popular in the media. Many in the drug and alcohol addiction counseling field consider this term misleading because it suggests that drug abusers are to blame for their illness because they have defective personalities. A better way to describe a person's predisposition to substance abuse might be psychological (mind-related) vulnerability. This means that the addict has or had some prior psychological factor that placed him or her at greater risk for substance abuse.

For example, people who have mood disorders may sometimes self-medicate (make themselves feel better or more in balance) by using prescription or illegal drugs. There are a number of personality traits that are thought to be shared by substance abusers. These traits include high emotionality; anxiety; immaturity in relationships; low frustration tolerance; inability to express anger; problems with authority; low self-esteem; perfectionism; compulsiveness; feelings of isolation; sex-role confusion; depression; hostility; and sexual immaturity. Stress is also

thought to be a factor contributing to substance abuse. This is not referring to run-of-the-mill, everyday stress from work or school, but the kind of stress that is the result of traumatic experiences, such as the sudden loss of a loved one. Stress in early childhood, such as having been sexually or physically abused, can also lead to substance abuse.

A sense of self is one of the most important factors in the potential for drug addiction. People with a strong sense of self appreciate their individuality and are aware of their talents and place in the world. They are able to begin, develop, and complete projects and to coexist comfortably in different types of relationships. People with a weak sense of self are more likely to seek out alcohol and drugs as way to boost their sense of self, but it quickly vanishes once the drug wears off.

According to addiction counselors and researchers, preventing substance abuse in young people is more about giving them good reasons to live and helping them to foster a strong sense of self rather than keeping them away from the dangerous and enticing world of drugs.

A family history of substance abuse is another powerful risk factor. Because substance abuse tends to run in families, much research has focused on pinpointing the genetic predisposition to substance abuse. Twin studies have found that the rates of use, abuse, or dependence on alcohol and drugs are higher for identical twins that have exactly the same genetic makeup than for fraternal twins that only share some genes. Other research found that genetic influences are stronger for abuse of some drugs than for others, and that abusing any category of drugs—such as sedatives, stimulants, opiates, or heroin—was associated with a greater likelihood of abusing every other category of drugs. Also, each category of drug had unique genetic influences, and heroin was the drug with the greatest genetic influence for abuse.

Family and social environmental factors also influence whether an individual begins using drugs. A poorly functioning family system may contribute to the development of an addiction just as powerfully as a genetic predisposition.

Adolescence is a time of change and risk. Because teens are just beginning to develop their fragile sense of self, they are more prone to fall victim to substance abuse. This vulnerability is heightened because teens are exploring identity, social skills, and independence. Peer pressure, the need to fit in and be liked, often causes teens to experiment with alcohol and drugs. If a teen is at a party and everyone around is partying, one

might feel compelled to take a drink or smoke cigarettes or marijuana. Usually these situations do not occur as they do in the movies, where other kids actually pressure their peers; rather, peer pressure tends to work in more subtle ways. If a teen is feeling left out and alone at a party, he or she might believe that joining others smoking marijuana will help to gain acceptance into a group of friends. This is a reflection of teens' needs to feel as though they are part of a group—that they belong.

A teen feeling like the odd one out might even turn to doing drugs in private as a way to escape the frustration or pain of loneliness. Since drugs and alcohol are often easily available to teens, and avoiding contact with them is often difficult, many teens will have encounters with substance abuse either with themselves or people they know. Willpower and a strong sense of self seem to be qualities that keep people from giving in to substance use, abuse, and addiction.

Amphetamines are central nervous system stimulants that give the user a temporary feeling of energy. A popular nickname for amphetamines is “uppers” because they make the user feel up and wide awake. Amphetamines have been used to improve performance—to stay awake, lose weight, or increase concentration—and to get high. When people use them to get high, they generally crush or dissolve them and then snort or inject the mixture.

Therapeutic doses of amphetamines stimulate the central nervous system, increase blood pressure, widen the pupils, quicken the breath, lower appetite, and decrease fatigue. Higher doses can cause agitation, blurred vision, tremors, and heart palpitations. Severe reactions can result in dilated pupils, sweating, cramps, nausea, heart problems, hypertension, panic, aggressive and violent behavior, hallucinations, delirium, high fevers, convulsions, and seizures. People have died from amphetamine abuse because of burst blood vessels, heart attacks, and high fevers. Physical dependence to moderate doses of amphetamines is highly unusual, but psychological dependence from even low doses is common. Chronic users of amphetamines have long-term health consequences. When long-term use of amphetamines is discontinued, withdrawal symptoms may include fatigue, depression, and disturbed sleep patterns.

Methamphetamine is an amphetamine that can be prescribed by a physician but is rarely prescribed because of its potential for abuse. Most of the methamphetamine sold on the street comes from foreign or U.S. laboratories, although it is also made in small, illegal laboratories, or even in private homes. Methamphetamine is a white, odorless, bitter-tasting crystalline powder that dissolves in water or alcohol and is taken orally, by snorting the powder, by injection, or by smoking. Some street names for it are meth, zip, go-fast, cristy, and chalk. In its crystalline form, the drug is called crystal meth, ice, Tina, or glass. When meth is mixed with water and injected with a needle it is called crank. Sometimes crank is mixed with crack cocaine. The mixture is called “croak.”

Methamphetamine abuse changes how the brain functions, and these changes may explain some of the problems users have thinking and controlling their emotions. Taking even small amounts of methamphetamine can produce increased wakefulness, increased physical activity, decreased appetite, increased respiration, and rapid

This photo provided by the Franklin County Sheriff's Department shows shake -and-bake meth ingredients found at house that burned from a meth lab explosion in Union, Missouri. Not only is meth bad for those who abuse it, the crude new method of making methamphetamine, by combining raw and unstable ingredients in a 2-liter soda bottle, poses a risk even to those who never get anywhere near the drug. .AP IMAGES/FRANKLIN COUNTY SHERIFF'SDEPARTMENT.

or irregular heartbeat, as well as increased blood pressure and body temperature.

Over time, methamphetamine abuse can cause many health problems, including extreme weight loss, severe dental problems, anxiety, confusion, sleeplessness, mood disturbances, and violent behavior. Chronic methamphetamine abusers also may become paranoid (extreme, irrational fear or mistrust of others), have hallucinations, or experience delusions, such as the feeling that they can fly or that insects are crawling under their skin.

Crystal meth is even more dangerous than the typical, older forms of amphetamines because it gets into the system faster, lasts longer, and can have even more deadly effects. In addition to tremors and convulsions, increased blood pressure, irregular heart rate, and intense anxiety, users also may have mood swings and violent thoughts and behavior.

Cocaine is another central nervous system stimulant. It comes from the coca plant, found in South America. (From 1891 to 1903,

the soft drink Coca-Cola contained extracts of the coca leaf.) Some street names for cocaine are blow, C, coke, and snow. It is usually snorted but also may be injected or smoked. At one time, cocaine was very expensive, and only the very wealthy could buy it. Crack is a form of cocaine that is smoked; it is much more potent (strong), cheaper, and sold in rocks. Crack is highly addictive; some experts say even one use has the potential to make someone addicted.

Cocaine causes an initial euphoric high that can last from 15 to 30 minutes. People on cocaine tend to talk rapidly and feel like they are invincible. Socially awkward people on cocaine jump out of their shells and act tremendously self-confident, often arrogant. A cocaine user may feel sexually stimulated at first, but as the drug wears off this usually doesn't last.

The high from cocaine is short-lived, and “crashing” quickly sets in. A person crashing from a cocaine high is usually depressed, paranoid, irritable, and extremely tired. Because the high is so brief, cocaine users tend to buy a large amount of the drug and go through it quickly. Cocaine has the reputation of being a social drug, and people tend to do it with groups in bars and clubs. For serious users, cocaine binges can last for days. On a binge, a user will snort cocaine every half-hour for days on end. They will live without sleep or food until they crash from exhaustion.

Cocaine is highly addicting, although it is not physically addictive in the way that narcotics, such as heroin, can be. That is, physical tolerance to cocaine does not develop. Rather, users need to take it again and again to avoid crashing. Even one-time use of cocaine can result in death.

PCP (phencyclidine) is a man-made drug that alters people's perceptions of sight and sound and makes users feel distanced and detached. Also known as angel dust, it usually looks like white or colored chunks, powder, or crystals. It is often smoked but also may be snorted or eaten. Low doses produce muscle stiffness and poor coordination, slurred speech, drowsiness, confusion, numbness of the arms and legs, profuse sweating, nausea, vomiting, flushing, and increased heart rate. Strange and violent behavior can result from higher doses. In some cases effects from PCP have lasted up to 10 weeks. Heavy users can experience deep anxiety, depression, and psychotic symptoms.

LSD can be taken in different forms. Because it is highly potent, only small amounts are necessary. It is sometimes produced in pill form. More commonly, sheets of LSD called blotter paper are produced. The user puts a tiny piece of the sheet in his or her mouth. These pieces are called dots, tabs, or doses. Sometimes acid is taken in liquid form. The effects of LSD are usually felt within an hour. Physical effects include increased blood pressure, dilated pupils, rapid heartbeat, muscular weakness, trembling, nausea, chills, and hyper-ventilation. (Sometimes LSD is mixed with amphetamines, and the effects match the speedy physical effects of that class of drugs.) Another possible effect of taking LSD is the flashback. Up to a year after the acid trip, users may have hallucinations caused by LSD left in their systems.

Mescaline is made from the peyote cactus. The heads or “buttons” of the cactus are dried and put into capsules. It is usually taken orally but also may be smoked or injected. It is less potent than LSD. Physical effects include dilated pupils, high body temperature, nausea and vomiting, and muscular relaxation. Mental effects include euphoria, heightened sensory perception, hallucinations, and difficulty in thinking. Higher doses can cause headaches, dry skin, hypotension (lowering of the blood pressure), cardiac depression, and slowing of respiration.

Designer drugs, called such because they are “designed” in a laboratory, were created in the 1970s by underground chemists attempting to subvert the drug laws of the day. The designer drugs were only a molecule or two different than some of the synthetic drugs then listed as illegal according to the Controlled Substance Act.

MDMA, better known as Ecstasy, is a very popular designer drug. Some street names for Ecstasy are X, E, XTC, Rave, or Adam. It is related to amphetamines and mescaline. It is also called the “love drug” or the “hug drug” because it enhances empathy and relatedness. It also causes a positive mood change, a drop in defense mechanisms, and elevated mood. Some of the negative effects of Ecstasy are the potential for overdosing, extreme fatigue, dilated pupils, dry mouth and throat, tension in the lower jaw, grinding of the teeth, and over-stimulation. It can also cause extreme paranoia and panic that call for emergency care.

Ketaminehydrochloride is another potentially deadly designer drug. It is a drug widely used as an animal tranquilizer by veterinarians during surgery. Also known as Special K or vitamin K, it is made by drying ketamine (often in a stove) until it turns from a liquid to a white, crystalline powder. It is a very powerful hallucinogen. It is usually snorted, but it is sometimes sprinkled on tobacco or marijuana cigarettes and smoked. Ketamine is frequently used in combination with other drugs, such as Ecstasy, heroin, and cocaine.

People high on ketamine may have profound hallucinations that include visual distortions and a lost sense of time, sense, and identity. Users report having profoundly terrifying experiences while high. Some report experiencing total temporary paralysis (loss of the ability to move or feel sensation). The high lasts anywhere from a half hour to two hours. Because users generally become unable to speak or even see what is

happening around them, it is not a social drug. Like other designer drugs, ketamine is often cut with other drugs and poisonous agents.

In 2010, awareness grew of several new synthetic stimulants packaged and marketed as “bath salts” (or sometimes “plant food”). The name bath salts comes from the white, crystalline form of the drug, which resembles legally sold salts used in bathing products, however the drugs are unrelated to such salts. Bath salts are found in head shops (stores where drug paraphernalia is sold), gas stations, and on the Internet under names such as “Zoom,” “Ivory Wave,” “Purple Wave,” “Cloud Nine,” “Vanilla Sky,” or “Bliss,” and are thus easy to access and inexpensive, leading to use by adolescents and teens. The drug is usually swallowed or smoked (though it can also be snorted or injected) to obtain a high similar to that of cocaine or amphetamines. Side effects can include headaches, panic attacks, agitation, paranoia, hallucinations, violent behavior, and even death.

The packages state that the products are not for human consumption in an effort to avoid being labeled as illegal drugs, and the makers of the products constantly tinker with the ingredients used to keep one step ahead of the authorities. However, after increasing reports of poisonings related to bath salts in 2011, the DEA banned three of the synthetic stimulants—Mephedrone, 3,4 methylenedioxypyrovalerone (MDPV), and Methylone—used to make such products. In 2012, Congress passed and President Obama signed the Synthetic Drug Abuse Prevention Act to ban dozens of different chemicals used to make the drugs. The act does not name specific recipes, so that all synthetic drugs like bath salts are covered.

Another recent designer drug is a synthetic version of marijuana commonly called spice, K2, incense, or potpourri, which, like bath salts, was sold legally on the Internet and in places like malls, convenience stores, and gas stations. The chemicals in such products are usually manufactured in China and then sprayed on incense that can be burned or leaves that can be smoked or made into a tea, leading to

a psychoactive high. Side effects can include vomiting, hallucinations, agitation, increased sweating, inability to talk, memory loss, high blood pressure, psychosis, violent behaviors, and death. As with bath salts, the manufacturers tried to stay one step ahead of the authorities by changing ingredients to keep the drugs legal, which means that the high and the side effects may be different each time someone uses a different formulation of the drug. However, the Synthetic Drug Abuse Prevention Act signed into law in 2012 now covers these products as well as bath salts.

Six to 12 hours after the last drink, an alcoholic can begin to feel the effects of withdrawal from alcohol. The stage one symptoms are psychomotor agitation, anxiety, insomnia, appetite suppression, stomach problems, elevated heart rate and blood pressure, sweating and tremors. Within 24 hours, stage two withdrawal symptoms begin. They include the symptoms of stage one, plus hallucinations and seizures.

Gambling can be a dangerous compulsion. Compulsive gamblers often spend all their money, exhaust their savings, and even resort to stealing money to support their habits. People can become addicted to betting on sports events, playing poker, or playing slot machines in bars and casinos. Something about the possibility of winning, perhaps the risk and the consequent adrenaline rush, spur on compulsive gamblers. Virtual casinos and online gambling sites are immediately available to those who cannot travel to popular gambling destinations like Las Vegas, Nevada, or Atlantic City, New Jersey. Easy online access to gambling has increased the numbers of teens that gamble. Unlike actual casinos, the Web sites do not require proof of age or an ID. As a result, the underage gamblers can gain instant access to virtual casinos.

The Center for Online Addiction (www.netaddiction.com ) exists to serve people with all forms of Internet addiction, including addiction to online gambling. Addiction to online auction houses, such as ebay, is another form of compulsive gambling.

Playing video games and using the Internet can be fun distractions, but computer addiction can occur. If a person starts to play video games compulsively or becomes addicted to various activities on the Internet, counseling may be suggested to help the person reintegrate with society. © PICTUREPARTNERS/ALAMY.

Internet addiction is a broad term that describes many kinds of compulsive behaviors. Many potentially addictive activities in real life are replicated on the Internet. The reason Internet addictions are a bit more dangerous is that people often feel secluded sitting in front of their computer screens. There is a sense that they won't get caught in the act.

According the Center for Online Addiction, there are different types of Internet addiction:

People who hide out in a cyber universe are often troubled and have difficulty socializing with real people. Counseling may help Internet addicts come out from behind their computers and rejoin the real world.

Exercise addiction is compulsive exercise that harms rather than improves people's health. People addicted to exercise think about exercise constantly and plan their every moment around the next time they can run, bike, take a class at the gym, or lift weights. They talk constantly about fitness. They begin to associate only with those people who will indulge their addiction: people who also exercise all the time. If someone gets really angry or depressed by missing a workout, or if he or she constantly exercises and stops taking part in other social activities, that individual might be an exercise addict.

Exercise addiction can lead to exhaustion and even death. Women may stop getting their periods, and men who are obsessed with muscles sometimes succumb to taking dangerous steroids to bulk up. For most people, a new exercise regimen, often under the supervision of a doctor or a trainer, is truly beneficial for their health. But in some cases, the healthful benefits of exercise are lost and replaced with the desperate need to exercise all the time.

Often exercise addiction is related to body image disorders, like anorexia nervosa, bulimia nervosa, and body dysmorphic disorder. In all three of these illnesses, people see themselves not as they are, but as a distorted, fat people who do not measure up to society's standards of thinness or fitness. (In the case of body dysmorphic disorder, fat is not always the culprit but rather a constant unhappiness with parts of, or the shape of, one's body.) Women and girls tend to suffer from this kind of disease most often, but increasing numbers of boys and men are affected too.

Exercise addiction can develop for other reasons as well. For instance, athletes can become addicted to training in their quest to improve their performance. Abuse of steroids can occur along with exercise addiction. Steroids are a class of drugs that increase the male hormone testosterone in the body. This increases muscle mass when accompanied by weight training. In the weight lifting world, there is a focus on looking “buff” or very muscular. Many men (and women, too) who weight train sometimes become so focused on the goal of attaining huge muscles that they turn to steroids as a means of bulking up.

Self harm, such as cutting, burning, hitting oneself, head banging, or hair pulling may be signs of a depression, personality disorder, or other disorder. Some people who self harm may also be suicidal. © LEILA CUTLER/ALAMY.

Self-injury or self-harm, often expressed by cutting or burning oneself, is considered an impulse-control behavior problem, but also may be symptom of another mental health disorder such as depression, a personality disorder, or it may occur along with an eating disorder. It is a dangerous, unhealthy way to deal with emotional problems such as pain, anger, and frustration. Self-injury may give people a brief moment of relief, but the painful emotions that caused it quickly return.

Self-injury is common among teenage girls, but anyone can develop this dangerous behavior. Those who self harm sometimes carve on their body with razor blades, stick themselves with pins, and squeeze and pinch their faces.

It is very important that people who self-injure receive therapy to uncover the reasons they are hurting themselves. Therapy aims to help people manage the issues that trigger the behavior. Recovering from self-injury may take a long time because it may have become a major part of a person's life and because it may be a symptom of another mental disorder.

A mania is an excessive or unreasonable enthusiasm for an activity, especially a destructive activity such as stealing or starting fires. Low levels of serotonin, a naturally occurring chemical in the brain, are common in people prone to impulsive behaviors.

Kleptomania is the compulsion to steal. Kleptomaniacs lead dangerous lives, stealing things every chance they get. It's not enough for them to simply shoplift from stores. Kleptomaniacs steal from their friends, teachers, and loved ones. Like other behaviors involving risk, the risk of getting caught seems to satisfy some need in people who compulsively steal.

Pyromaniacs are people that feel compelled to start fires. This compulsion not only may kill the person who sets the fire, but also anyone caught in the way. Experts believe that some firesetters may be seeking attention while others are thrill-seekers. Teens who set fires often have committed other crimes such as vandalism or sexual offenses. Pyromaniacs are often angry people, but the anger is often suppressed. Setting fires is a way for them to express their anger. Usually pyromaniacs don't get help until it is too late. A serious fire is often the event that forces them into therapy.

Compulsive shopping is an addiction that causes people to run up their credit card bills and get so buried in debt that they sometimes have to declare bankruptcy (legally declare themselves unable to pay their bills due to lack of money). Many people, at one time or another, purchase an item that they do not really need or want. Compulsive shoppers, however, go on frequent shopping sprees and buy many things that they just don't need at all. Somehow, standing in front of the item before they buy it, they believe that their lives will be better if they own the item. As a result, they end up with closets full of unnecessary items.

Compulsive shoppers are searching for love in the form of material objects. They experience tension or anxiety before they make a purchase,

and a sense of relief following the purchase. Often they continue shopping until a loved one stops them or they lose everything to debt. Compulsive shopping tends to run in families, and many people with this disorder also suffer from depression, anxiety, substance abuse disorders, and eating disorders.

Sex addiction is the compulsion to repeatedly seek out people and have sexual relations with them. Sex addicts put themselves in dangerous situations regularly just to fulfill their need to have sex. People who are sex addicts sometimes meet strangers in bars, or almost anywhere, and go some place with that stranger to engage in casual sexual activity. Of course, when a stranger is involved there is a great deal of danger from potential personal harm. People who engage in such behaviors are not just being promiscuous; rather, they are psychologically driven by their sex addiction.

Sex addiction is treatable. Once addicts confront and accept their behavior, they can begin to look at the reasons why they are compelled to have sex all the time. Often sex addicts experienced sexual abuse (when a person is forced to engage in sexual activities against his or her will) as children. Their sex addiction is a way of having control over their bodies and the act of seduction they compulsively perform is a way of controlling a partner. Sex addiction is never connected to healthy love and desire.

Most sex addicts deny their addiction, and successful treatment of addiction requires that people admit that they have a problem. Often, a crisis—such as the loss of a job, the end of a marriage, or illness—must occur before sex addicts seek treatment. Treatment focuses on controlling the addictive behavior and helping the person develop a healthy sexuality. Support groups and 12 step recovery programs for people with sexual addictions, such as Sex Addicts Anonymous, help many people to recover.

Anorexia nervosa is a condition in which a person refuses to maintain a healthy body weight (persons whose weight is at least 15 percent below their normal body weight fall into this category). Anorexic people starve themselves, even though they may be very hungry. They become terrified of gaining weight and obsessed with food and weight. They often develop strange eating habits, refuse to eat with other people, and exercise strenuously to burn calories and prevent weight gain. People with anorexia continue to believe they are overweight even when they are dangerously thin.

This condition often begins when a girl or young woman who is slightly overweight or normal weight starts to diet to lose weight. After losing weight she wanted to lose, she continues her efforts to lose weight, and dieting becomes an obsession. People with anorexia take pleasure in how well they can avoid eating and measure their self-worth by their

ability to lose weight. Eating and weight gain are viewed as weaknesses and personal failures.

In addition to avoiding eating whenever possible, anorexics will often display high levels of energy that seem at odds with their frail physical conditions. They may also develop odd oral habits, including chewing gum throughout the day, drinking an excessive amount of coffee or diet soda, and chain-smoking.

The medical complications of anorexia are similar to starvation. When the body attempts to protect its most vital organs, the heart and the brain, it goes into “slow gear.” Menstrual periods stop, and breathing, pulse, blood pressure, and thyroid function slow down. The nails and hair become brittle, the skin dries, and the lack of body fat produces an inability to withstand cold temperatures. In addition, personality changes may occur. The person suffering from anorexia may have outbursts of anger and hostility or may withdraw socially. In the most serious cases, death can result.

Eating a plate full of French fries is something most teens do occasionally. However, if there is a repeated cycle of binge eating followed by purging, the teen is suffering from bulimia. Such disorders are often difficult to diagnose and treat because of the secretive nature of the illnesses. © DENISE HAGER/CATCHLIGHT VISUAL SERVICES/ALAMY.

People who suffer from bulimia eat compulsively and then purge (get rid of the food) through self-induced vomiting, use of laxatives (drugs that induce bowel movements), diuretics (drugs that expel water from the body through urination), enemas (a process that expels waste from the body by injecting liquid into the anus), strict diets, fasts, exercise, or a combination of several of these compensatory behaviors. Bulimia often begins when a person is disgusted with the excessive amount of food consumed and vomits to get rid of the food and calories.

Many bulimics are at a normal, healthy body weight or above because of their frequent binge-purge behavior, which can occur from once or twice a week to several times per day. Many bulimics who maintain normal weight may manage to keep their eating disorder a secret for years. As with anorexia, bulimia usually begins during adolescence or young adulthood.

A particularly stressful event or depression often triggers an episode of binge eating. The binge eating may temporarily relieve

a bulimic's feelings of depression or stress, but often deeper feelings of depression, disappointment, and anxiety will follow, which in turn triggers an episode of purging. Many bulimics report feeling out of control when bingeing and use similar terms to describe their need to purge their bodies of the food they just consumed.

Binge eating and purging are dangerous. Purging can result in life-threatening heart conditions because the body loses vital minerals. The acid in vomit wears down tooth enamel and the lining of the esophagus, throat, and mouth and can cause scarring on the hands when fingers are pushed down the throat to induce vomiting.

Many bulimics suffer from low self-esteem and may even have suicidal thoughts. Often they are rigid perfectionists who think in absolutes (“I am bad because I ate that”). Like anorexics, bulimics will make negative statements about their bodies and suffer extreme guilt after eating even normal portions of food. They may begin to withdraw from social activities, particularly those that will make it difficult for them to purge without suspicion.

Binge eating is a common problem among people who are overweight and obese. Besides consuming unusually large amounts of food in a single sitting, binge eaters generally suffer from low mood and low alertness and experience uncontrollable compulsions to eat. They have food cravings before binge episodes and feelings of dissatisfaction and restlessness after binges.

The National Institute of Mental Health (NIMH is one of the National Institutes of Health) reports that binge-eating disorder is the most common eating disorder. Nearly 3% of adults will have a binge-eating disorder at some point in their life.

People who suffer from binge eating often:

Binge eaters usually suffer from obesity (extreme overweight). Many have been “yo-yo” dieters (experiencing large ups and downs in weight from a cycle of dieting) their entire lives.

There are factors contributing to the development of eating disorders that are biological, or genetic. For example, if a person has a relative in her immediate family with an eating disorder, she is at a higher risk to develop an eating disorder.

Disordered eating also may be triggered by the initial act of starving, binge-eating, or purging. This is because these behaviors can change an individual's brain chemistry. Starvation and overeating can both lead to the production of brain chemicals that induce feelings of peace and euphoria (happiness). These good feelings mask feelings of anxiety and depression, both of which are commonly experienced by people suffering from eating disorders. This has caused some researchers to conclude that some people with eating disorders may use food (or starvation) as a way to relieve depression, anxiety, or other emotional upset.

People suffering from eating disorders share many of the same personality traits. For example, eating-disordered people lean toward being perfectionists. Many of them suffer from low self-esteem, despite their accomplishments and perfectionist ways. Extremist thinking, too, is present in many people with eating disorders. They assume that if being thin is “good” then being even thinner is better. This leads to the thought that being the thinnest is the absolute best; it is this thinking that pushes some anorexics to plummet to body weights of 50 or 60 pounds.

Often, people who live with eating disorders have no sense of self. They simply do not feel that they know who they are or their place in the world. An eating disorder, however, offers a sense of identity to these individuals in that it enables them to say, “I am thin,” and “I am dieting.” This eventually leads them to define themselves solely on their appearance and their dangerous actions rather than with their positive qualities and accomplishments.

Eating disorders, in general, occur primarily in industrialized societies, such as the United States, Australia, Canada, Europe, and Japan. In all of these places, the media (TV, movies, magazines) bombard people with the virtues and importance of being thin. Television, movies, magazines, and advertisements promise that being thin will bring a person success, power, approval, popularity, friends, and romantic relationships. Women, in particular, are held to an almost-impossible-to-achieve standard of physical fitness and beauty, the height of which is

being slender and thin. (In fact, female fashion models now weigh an average of 25% less than an average woman.) Because of these media messages, and how young women report feeling about their weight and body shape, a link between eating disorders and social pressures can be established.

Social factors that may contribute to eating disorders include rigid definitions of beauty that exclude people who do not conform to a particular body weight and shape; cultures that glorify thinness and overemphasize the importance of obtaining a “perfect body”; and cultures that judge and value people based on external physical appearance rather than on internal qualities such as character, intellect, generosity, and kindness. Appearance-driven concerns, rather than health needs, continue to motivate many people to lose weight. Society emphasizes these appearance-driven concerns by describing overweight and obese people in a negative manner.

People are shaped in part by their experiences with their families. Families contribute to an individual's emotional growth. If someone is raised in a dysfunctional family, he or she may have feelings of abandonment and loneliness. Certain families have dynamics in which rigidity, overprotectiveness, and emotional distance are commonplace. If parents make all of a child's decisions for her, when she becomes a teenager and must make decisions for herself, she may find she doesn't have the tools to do so. All of these dynamics can promote the development of eating disorders in the future.

Families in which unrealistically high expectations are placed on children also may lead people to develop disordered eating. The disordered eating is used as a way to cope with feelings of inadequacy and as a way to control at least one area of their lives.

Children also receive their first messages about their bodies from their families. If parents place too much emphasis on physical appearance, it can lead to low self-esteem in those children, placing them at risk for developing eating disorders when they are older.

Most children learn their eating habits and food preferences from their families. Often times, cleaning one's plate or not eating too much or even parents' close control of the food their children eat can lead to disordered eating later in life. Parents' attitudes toward food and their own bodies greatly affect children's attitudes toward food and how they will feel about themselves.

Eating disorders are often set off or triggered by an event or a circumstance in the life of an individual who is already prone to developing such a condition. A period of adjustment, such as leaving home to attend summer camp, prep school, or college, can easily

trigger disordered eating in an individual with such tendencies already in place. A traumatic event in someone's life, such as sexual abuse, can also trigger the development of an eating disorder. Other triggers may seem harmless yet represent large life changes, such as moving, starting a new school or job, graduation, and even marriage. Triggers are usually closely tied to the end of a valued relationship or a feeling of loneliness.

The most common trigger of an eating disorder, however, is dieting. Very often dieting can lead people to disordered eating of some sort, including anorexia or bulimia.

Anorexia causes many physical problems. For instance, it upsets the normal functions of hormones. For girls, this means the body is unable to produce enough of the female hormone estrogen because it does not have enough fat. This may cause an absence of menstrual cycles, called amenorrhea. For boys, anorexia causes a decrease in the production of the male hormone testosterone, which results in a loss of sexual interest.

An anorexic body lacks the protective layer of fat it needs to stay warm. To compensate for the lack of fat, lanugo (fine hair) will grow all over the body to keep it warm. Another problem anorexia causes is a decrease in bone mass. The body needs calcium for strong bones. Since an anorexic is not eating enough food, which is the source of calcium, the body's bones suffer and weaken. Later in life, this could

result in dangerously thin, fragile bones—the condition is known as osteoporosis.

Additionally, without the fuel it needs, an anorexic's body will respond as if it is being assaulted and begin to fight back in order to survive. To survive the body must have energy, but because the body has no food to turn into energy, it seeks out the muscles, and eventually, the organs (heart, kidneys, and brain) for sustenance—often causing permanent damage to the organs in the process. This is the most serious consequence of anorexia and can lead to cardiac arrest and/or kidney failure, both of which may result in death.

The frequent purging that occurs with bulimia does serious damage to the body. Self-induced vomiting can severely damage the digestive system. Repeated vomiting also damages the esophagus (throat) and eventually it may tear and bleed. Vomiting brings stomach acids into the mouth, causing the enamel on the teeth to wear away. As a result, the teeth may have cavities, become weakened, and appear ragged.

Other consequences include swollen salivary glands, which gives some bulimics the appearance of having chipmunk cheeks, and cuts and sores on the knuckles from repeatedly sticking one's fingers down the throat to induce vomiting (known as “Russell's sign”). Stomach cramps and difficulty in swallowing are also common.

If laxatives (drugs that induce bowel movements) are abused, constipation may result because the body can no longer produce a bowel movement on its own. Abuse of laxatives and diuretics (drugs that expel water from the body through urination) can also cause bloating, water retention, and edema (swelling) of the stomach. Because the body is being denied the nutrients and fluids it needs to survive, the kidneys and heart will also suffer. Specifically, a lack of potassium will result in cardiac abnormalities and possible kidney failure, which may also result in death.

The physical effects of binge eating are not as severe as those of anorexia and bulimia because the body is not denied food or put through the painful process of purging. Nevertheless, there are some potentially serious consequences for binge eaters.

Since binge eaters may suffer from obesity, health complications such as diabetes or heart problems can develop. Health problems from yo-yo dieting can include hypertension (high blood pressure) and long-term damage to major organs, such as the kidneys, liver, heart, and other muscles.

Many anorexics and bulimics exercise compulsively in order to lose weight. Compulsive exercise is extremely dangerous and can cause many painful injuries, including stress fractures, damaged bones and joints, as well as torn muscles, ligaments, and tendons. Even worse, the injuries may become more serious as many compulsive exercisers often continue their routines despite their injuries.

When an eating disorder is successfully treated, the body can heal and return to normal. Sometimes, however, the eating disorder has continued for so many years that there is too much damage for a full recovery to occur. A person may have to live with a weak heart or kidneys for the rest of his or her life. A woman may be unable to conceive a child because her reproductive system cannot function properly or may suffer from the debilitating bone disease osteoporosis.

The psychological consequences of eating disorders are complex and difficult to overcome. An eating disorder is often a symptom of a larger problem in a person's life. The disorder is an unhealthy way to cope with the painful emotions tied to the problem. For this reason, the emotional problems that triggered the eating disorder in the first place can worsen as the disorder takes hold.

Research has shown that many people suffering from an eating disorder also suffer from other psychological problems. Sometimes the eating disorder causes other problems, and sometimes the problems coexist with the eating disorder. Some of the psychological disorders that can accompany an eating disorder include depression, obsessive-compulsive disorder, and anxiety and panic disorders.

In addition to having other psychological disorders, a person with an eating disorder may also engage in destructive behaviors as a result of low self-esteem. Just as an eating disorder is a negative way to cope with emotional problems, other destructive behaviors, such as self-injury and substance abuse, are similar negative coping mechanisms.

Depression is one of the most common psychological problems related to an eating disorder. It is characterized by intense and prolonged feelings of sadness and hopelessness. In its most serious form, depression may lead to suicide (the taking of one's own life). Considering that an eating disorder is often a secret, a person who is suffering feels alienated and alone. A person with an eating disorder may feel that it is impossible to openly express his or her feelings. As a result, feelings of depression may worsen the effects of an eating disorder, making it difficult to break the cycle of disordered eating.

With counseling and support, it is possible to combat these negative feelings and prevent them from progressing over time. Psychotherapy, especially cognitive behavioral therapy and other “talk” therapies, can help ease feelings of depression, which in turn gives a person better tools with which to fight an eating disorder.

Obsessions are constant thoughts that produce anxiety and stress. Compulsions are irrational behaviors that are repeated to reduce anxiety and stress. People with eating disorders are constantly thinking about food, calories, eating, and weight. As a result, they show signs of obsessive-compulsive behavior. When people with eating disorders also show signs of obsessive-compulsive behavior with activities and things not related to food and weight, they may be diagnosed with obsessive-compulsive disorder (OCD).

Some obsessive-compulsive behaviors practiced by eating disorder sufferers include storing large amounts of food, collecting recipes, weighing themselves several times a day, and thinking constantly about the food they feel they should not eat. These obsessive thoughts and rituals worsen when the body is regularly deprived of food. Being in a state of starvation causes people to become so preoccupied with everything they have denied themselves that they think of little else.

Everyone experiences feelings of anxiety (fear and worry), guilt, and shame at some time; however, these

Those with eating disorders generally have distorted body images, usually thinking their bodies are much larger than they actually are. © MIKEHEYWOOD/SHUTTERSTOCK. COM.

feelings become more intense with the onset of an eating disorder. Eating disorder sufferers fear that others will discover their illness. There is also a tremendous fear of gaining weight.

As the eating disorder progresses, body image becomes more distorted, and the eating disorder becomes all-consuming. Some sufferers are often terrified of letting go of the illness, which causes many to protect their secret eating disorder even more.

Eating disorder sufferers have a strong need to control their environment and will avoid social situations where they may have to be around food in front of other people or where they may have to change their

behavior. The anxiety that results causes people with eating disorders to be inflexible and rigid with their emotions.

Bulimics and binge eaters, specifically, experience guilt and shame about their disorders. This is mainly because, unlike anorexics, they are not usually in denial, and they do realize that there is a problem. Bulimics will feel anxiety before, during, and after a binge and can only relieve this anxiety through purging. Purging, however, brings on overwhelming feelings of guilt and shame. Binge eaters also feel anxiety during a binge, but because they do not purge, they feel ashamed over their lack of control around food.

It is common for people with eating disorders also to struggle with drug and/or alcohol addiction. In fact, research shows that one-third of bulimics have a substance-abuse problem, particularly with stimulants (drugs that excite the nervous system) and alcohol. This may stem from the fact that people with eating disorders have difficulty coping with their emotions and use negative means, such as drugs, to mask their problems. Drugs and alcohol provide temporary escapes from reality but, similar to eating disorders, can progress into serious problems that require treatment to overcome.

The first step in preventing the development of eating disorders is to reorder feelings and thoughts about food and weight. Eating disorder experts recommend that people reject unhealthy messages about weight, body shape, and diet. Since body shape and weight are determined mostly by genetics, there is only so much a person can do to control or change weight and body shape. Trying to fight against or change the body's set point (the weight at which one's body naturally falls) is unhealthy and possibly dangerous because it creates a cycle of yo-yo dieting. Research has shown that while not every diet leads to eating disorders, 80 percent of eating disorders are initially triggered by dieting.