NEW YORK -- Bathing suit season, anticipated with frenzied dieting and exercise, can be an especially perilous time for sufferers of eating disorders like anorexia nervosa.
Increased anxiety about body image, coupled with high temperatures, make the season doubly dangerous for anorexics, according to psychiatrists who treat the disorder.
'I'm already seeing up to 20 percent more patients now than during the winter. People are calling from all over. Colleagues are making referrals,' said Dr. Charles Murkofsky, who is director of the Eating Disorders Program of Gracie Square Hospital in Manhattan.
'I think what's looming is the swimming suit season, and that's no small item if you think you are grotesquely obese ... The obsession with how their bodies look tends to increase, with purging, exercising and starving to prepare for the beach,' said Murkofsky.
Anorexia is marked by excessive weight loss, often accompanies by obsessive exercising. Murkofsky treats advanced cases of the psychiatric disorder, which can lead to kidney, heart and even brain damage.
Another expert agreed that warm weather was bad news for anorexics.
'There's an increase in the number of problems at this time. They start eating abnormally because they're so uptight about how they look in bathing suits and skimpy clothes,' said Dr. Michael Nussbaum, who primarily treats teenagers in early stages of the illness.
'Their legs may look like toothpicks, but they look at them and see tree trunks. So they try to get in shape for summer, like we all do, but in inappropriate ways,' Nussbaum said recently at Long Island Jewish Medical Center in New Hyde Park, N.Y.
Anorexics may prepare for summer by more severely restricting their food intake, and also with fanatical increases in physical exercise.
'Over-exercising is very typical. It's a kind of purging behavior which anorexics and bulimics take on very frequently,' Murkofsky said.
'They'll work out hours at a time, but it's never enough. They (feel they) can't burn enough calories,' he said.
While anorexia nervosa literally means, 'nervous loss of appetite,' it appears typically to involve a conscious decision to diet, with weight losses of roughly 25 percent of body weight or even more. In some cases, anorexics also suffer bulimia, a disorder marked by eating binges followed by forced vomiting.
The disturbance is most common among young women and tends to develop between the ages of 14 and 18, though it can emerge even in the third decade of life.
Summer weather, especially during heavy exertion, can be very dangerous to those who are severely underweight and already experiencing fluid depletion and electrolyte imbalances, said Murkofsky.
'Most anorexics are so physically deteriorated that they are unable to tolerate any extremes in temperature. Hot and humid weather accentuates their already present risk for dizziness, amnesia, fatigue and imbalance, as well as for heat exhaustion and prostration,' he said.
'In extreme cases, you can have a cardiac event,' he noted.
During very hot weather, sufferers of anorexia should not exercise, should remain calm, wear light clothing, take cool showers and stay in air-conditioned areas.
Anorexics already are at risk for internal organ shrinkage and permanent kidney damage, said Murkofsky, emphasizing that extra monitoring of patients' physical conditions was important during the summer.
Psychiatric treatment, usually with behavior modification therapy, early in the course of the illness, is most often successful, said Murkowsky, whose 20-bed unit is generally full.
'The irony and paradox is that the more emaciated they become, the more convinced they are that they are obese. Then it's really an uphill battle to get them to change their behavior,' he said.
The National Institute of Mental Health in Bethesda, Md., is conducting a study of patients with the disease in its Eating Disorders Unit, said Joy Cassette, a clinical social worker and researcher with the program.
She said bulimia is found in at least 5 percent of women between the ages of 18 and 25 and anorexia in perhaps 0.1 percent, although some studies have estimated up to 20 percent of these women experience eating disorders of some kind.
Cassette agreed with Murkosky and Nussbaum, who said eating disorders overall are becoming more common.